1.5.1 Medical Decision-Making and Children
Samantha Brennan, PhD
Updated December 11, 2013
- To understand the basis of a child's right to have a say regarding his or her medical treatment
- To consider what ought to happen when a child's view regarding treatment differs from that of his or her parents
Amanda Parker is a 10-year-old girl who was injured in a fire in which she suffered second degree burns on one of her legs. After some initial healing while in the care of the hospital's burn unit, Amanda underwent skin graft surgery and stayed in the hospital for two weeks while recovering. A year has passed now since the accident, and Amanda's surgeon has followed up on Amanda through the burn unit's outpatient clinic. The surgeon is now presenting Amanda and her family with the option of a second surgery. This surgery will involve a second graft, and its primary purpose is to improve the appearance of the scar tissue. Amanda's parents are quite keen to proceed with the surgery, fearing that their daughter will suffer long-term consequences from living with burn scars. They find the scars difficult to look at and want Amanda to be able to lead a normal life, wearing a bathing suit at the beach for instance, without attracting the attention and pity of strangers. Amanda has a different opinion. She thinks that the pain of the surgery and the hospital stay outweigh the benefits. She is an articulate child who says that she doesn't care so much what her leg looks like or what other people make of her appearance. She presents her opinions forcefully, but her parents still want the surgery to proceed. They think that she will change her mind about how much appearances matter and that the pain and inconvenience of surgery will fade over time.
- What course of treatment is in Amanda�s best interest? What role does Amanda play in deciding this?
- Of all the parties involved, other than Amanda, Amanda�s parents know her best. Does this knowledge give them the right to decide for Amanda?
- What difficulties appear when the parents do not appear to be acting in the child�s best interests? When can the parents� choices be overridden?
- How old should children be before they get to make decisions regarding their medical care?
- What are the dangers, if any, in approaching this as a "family decision"?
- What "compromise" options are available to Amanda and her parents? How can physicians help the family move to a compromise?
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