The debate over whether an adult patient deserves autonomy, or deserves their autonomy to be respected is a never-ending struggle. Many issues may serve to prevent adults from having their own autonomy, such as the patient’s mental stability, the patient’s ability to verbalize their wishes, and the patient’s age. In order to adhere to the “best interest standard” that Robert M. Veatch discusses, a surrogate must make the decisions regarding the patient’s health plans for the best interest of the patient. As Veatch indicates, this form of deciding what option best suits a patient’s health and life is “complex and subjective” (Veatch 319), especially if the wishes of the patient is not known by the surrogate. There is also a great deal of fog when deciding who can best act as a surrogate and decide the best health option for the patient.
So how does this work for a child? Who serves as their decision-maker; the state, the health-care provider or the parent? And what is the “best interest standard” in their case?
Many obese teens and their parents may be desperately searching for a solution to the problem of obesity and may turn to bariatric surgery. Many families may see this decision as a morally good decision and may support their child in their efforts to live a better life wholeheartedly. As specified by Veatch, well-being will be maximized after bariatric surgery because it would improve psychological, social, aesthetic, and even occupational well-being (Veatch 321). However, the decision to participate in this life-changing procedure does not reside with the patient or the family, but with the pediatricians, dieticians, social workers, and surgeons that may be involved in the patient’s life. Thus, if these outside individuals did not believe that the patient was “ready” or prepared to partake in this new journey, the patient will be regrettably barred from the procedure. Considering that the patient is able to communicate their desires, shouldn’t their autonomy be respected? Why is the autonomy that stems from a rational decision that is made by true beliefs not respected? And this decision will be made to improve the lives of the children who want to participate in this surgery, so why won’t doctors allow it?
Circumcision is also another much debated topic that can make one think about where decisions may lie. Circumcision is known to have many benefits such as the prevention of STI’s and the decrease in HIV transmission. Many parents opt to provide their sons with circumcisions at birth and may assume that their sons may not be upset with the decision, however, Frank, an individual from Los Angeles is upset that he had to undergo the painful circumcision and that he did not have an option to say yes or no. While a newborn, the surrogate who can make the decisions tends to be the mother and father and if they choose to perform circumcision, it is because they believe they are practicing good paternal and are hedonistically serving their child’s best interest. However, the child may grow up and not think so. So is it moral that the autonomy of this decision stays with the parent even though the child may not agree with this decision later on? James F. Childress explains that some health care providers may make a decision disregarding patients autonomy believing the patient will “ratify the coercive or deceptive treatment on her behalf, thanking the professional,” (Childress 311).
As infants and children may have the right to autonomy but their autonomy can be overshadowed and disregarded for the decisions of a better informed, more rational surrogate such as a physician and doctor, one can begin to wonder who really deserves to be the voice of the child. In a situation when a child is on life support but has a bleak chance of survival or a good life, does the parent decide to keep their child alive? Should the physician decide to allow the patient to rest at peace? And who is making the “best choice” for the patient?
References:
Childress, James F. “The place of autonomy in bioethics.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 311.
Veatch, Robert M. “Abandoning Informed Consent.” Arguing About Bioethics. By Stephen Holland. London: Routeledge, 2012. 317-328.
http://www.cnn.com/2011/HEALTH/04/14/teens.circumcision.ep/index.html
http://www.cnn.com/2011/HEALTH/06/22/surgery.obese.teens/index.html
http://www.medicinenet.com/circumcision_the_medical_pros_and_cons/article.htm#what_has_been_the_medical_view_of_circumcision
I think’s it’s practically impossible to make the “best choice” for a patient. The final decision may be the least undesirable, chosen from a series of undesirable options. Of course, the decision, whether opposed or granted by a physician or doctor should not disagree with the patient’s wished… Childress does say that the patient will “ratify the coercive or deceptive treatment on her behalf, thanking the professional,” however, he mentions that sometimes this is not the case. When this is not the case, and the patient experiences adverse outcomes, there can be consequences. The patient could be very upset that their right to autonomy was disrespected; there could be physical consequences to the patients such as a surgery gone awry or unbearable side effects to a treatment they didn’t want, and there could be malpractice lawsuits against the doctor. This is why doctors try to fully inform patients of their options and allow patients to make the final decision- the doctor avoids malpractice liability.
In this article I found, the author (Timothy E. Quill, MD) says the physician power was lost in the United State’s transition from paternalism to autonomy. He also explains why physician power is vital to making the best choice for a patient. “By taking the risk of informing patients about their own feelings, values, and recommendations, physicians can deepen and enrich medical decisions so that they are both personal and professional” (Quill). This provides the patient with an opportunity for weighing options and an expert’s opinion on the matter. (The doctor should suggest alternative options and the pros and cons of each…) In my opinion, doctors shouldn’t be afraid to give their two cents, as long as the decision is ultimately chosen by the patient.
Quill, T.E. MD & Brody,H MD, PhD. (1996) Physician Recommendations and Patient Autonomy: Finding a Balance between Physician Power and Patient Choice. Annals of Internal Medicine, 125(9), 763-769. Retrieved from http://annals.org/article.aspx?articleid=710110.
Unfortunately, there is no way of knowing what is “best” for the child or infant. There is no instruction manual on how to be the best parent. Still, parents must be able to act decisively on what they “think” is best for their child. In the case of medical care, parents still have this responsibility; nevertheless, it is the physician’s duty to fully inform the parents of the consequences of a certain treatment as well as its alternatives. Physicians such as pediatricians can also be excellent sources of advice. After all, they have come across various diverse family situations and have medical and scientific knowledge to help back up their claims. Good parents must be able to consider all of this information and combine it with their parental intuition about their child in order to make the best informed decision on how to care for their child. Sadly, regardless of what the parents think is best, children may disagree with their parents’ decisions as they get older. However, there are instances in which the child grows up to realize that even though they didn’t understand what their parents were doing when they were little, they now agree with and may even thank their parents for their decisions.
I think that the “final decision” should be made by both the physician and parent working together. It is important that the parent and physician make a unified decision because while the physician has the medical experience and background about the patient, the parent knows what it’s in the patient’s best interest and what the parent would want for his or her child.
However, i also believe that if the child is old enough to make rational decisions for himself or herself, he or she should definitely be able to have input and give legitimate reasons why he or she may opposed the parent or physician. If the physician and parent agree on something and the child disagrees, the physician and the patient’s decision should be made. In the end, I think the child would thank physician and parent for the outcome.
There are situations where the physician and patient oppose each other. But, it’s extremely important that they reach a happy medium. Again, the physician knows the proper medical point of view, while the parent would know the patient’s personal preferences and background. Therefore, the final decision needs to be a combined effort between physician and parent.
I think this conversation about the child and the parent gets particular interesting as the child ages and still relies on the parents’ financial support, particularly for healthcare. The discussion extends beyond what decisions to parent is making for the child towards debate about minor’s confidentiality and parental notification. There are not extensive laws regarding this issue, but there are some state laws that require parental notification of certain diagnoses or procedures. But where is the line drawn to protect the minor’s privacy?
Advocates for youth discusses this issue and defines the issue with current states laws: “These laws elevate the interests of the parent or guardian above those of the adolescent patient. By making a minor’s health information available to the parent, the laws may well discourage teens from seeking needed care. An adolescent with a sexually-transmitted disease, for instance, may forego treatment rather than risk a parent’s embarrassment, disapproval, or violence.” (source: http://www.advocatesforyouth.org/publications/publications-a-z/516-adolescent-access-to-confidential-health-services)
Therefore, as a child ages and his/her health becomes more personal and independent from their parents I think that the system needs to account for this my protecting confidentiality. I think there needs to be a homogeneity between states to realize those sensitive areas in health and seek to protect minor’s privacy at the cost of parental notification. In the case of dysfunctional families, the protection of confidentiality may have a huge effect on the minor’s health and the minor’s willingness to seek help. These sensitive areas include: sexual health, mental health, and drug/alcohol treatment.
I agree that the realm of decision making regarding children is uncertain. Instinctively I think we would want to say that the parent is the one with the right to make decisions about children, because after all, it is their child. But even saying that almost makes me hesitate, because what does that really mean? It’s their child. They own that child? They possess that child? That child has their DNA? So they can do whatever they want with that child? Obviously, no, a parent cannot do whatever they want with their child because there are many instances in which Child Services or even doctors are legally allowed to step in and make decisions about that child. So obviously there is a limit to the parent’s right to make decisions regarding even their own children. What this limit is however, is sometimes blurry. Especially when it comes down to determining what is “best” for the child. As most people said, its pretty impossible most of the time to actually know what’s best. So it makes sense that Doctors, as well as parents should be able to weigh in when it comes to determining what is as close to best for the child as we can really determine.
nice post.