Of Love and Laetrile: Medical Decision Making in a Child's Best Interests

1979 ◽  
Vol 5 (3) ◽  
pp. 269-294
Author(s):  
Eve T. Horwitz

AbstractTwo recent cases have raised important questions concerning the appropriateness of state intervention in parental choices of unorthodox medical treatment for children with life-threatening conditions. This Note first discusses whether, and if so, when, state intervention in a child's treatment selection by its parents is appropriate, and then analyzes the tests a court should apply in deciding upon an appropriate treatment. The Note recommends a decision-making approach that requires the appropriate state agency to prove, by clear and convincing evidence, that the parents' choice of medical treatment either is directly or is indirectly harming their child. Under this approach, if the state meets its burden of proof the court then must apply the ‘best interests’ test, rather than the ‘substituted judgment’ test, to choose an appropriate medical treatment for the child.

10.2196/19428 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e19428
Author(s):  
Liheng Gong ◽  
Xiao Zhang ◽  
Ling Li

Background During cardiac emergency medical treatment, reducing the incidence of avoidable adverse events, ensuring the safety of patients, and generally improving the quality and efficiency of medical treatment have been important research topics in theoretical and practical circles. Objective This paper examines the robustness of the decision-making reasoning process from the overall perspective of the cardiac emergency medical system. Methods The principle of robustness was introduced into our study on the quality and efficiency of cardiac emergency decision making. We propose the concept of robustness for complex medical decision making by targeting the problem of low reasoning efficiency and accuracy in cardiac emergency decision making. The key bottlenecks such as anti-interference capability, fault tolerance, and redundancy were studied. The rules of knowledge acquisition and transfer in the decision-making process were systematically analyzed to reveal the core role of knowledge reasoning. Results The robustness threshold method was adopted to construct the robustness criteria group of the system, and the fusion and coordination mechanism was realized through information entropy, information gain, and mutual information methods. Conclusions A set of fusion models and robust threshold methods such as the R2CMIFS (treatment mode of fibroblastic sarcoma) model and the RTCRF (clinical trial observation mode) model were proposed. Our study enriches the theoretical research on robustness in this field.


Author(s):  
Mabrouk Shneeb Zarrouk Nafkha Mabrouk Shneeb Zarrouk Nafkha

Medical treatment is mutual consent between two parties, the doctor on the one hand, and the patient on the other, to conduct a therapeutic intervention, which is initially the main goal of this research. By adopting an analytical and descriptive methodology for legal texts, opinions of jurisprudence, and judicial jurisprudence, the physician is free, in principle, to select and contract with his patients. This is what the study aims to clarify. The physician has the right to consent to contracting with or rejecting a specific patient, regardless of the nature of the motive. A doctor, like other people, has complete freedom to practice his profession in the manner that he pleases. As he has the right to accept or reject the invitation for treatment, he is not obligated to answer the patient's request. A critical reading of these texts and a comprehensive look at the opinions reveal that the doctor's refusal of treatment could come as a result of professional reasons and/or personal reasons. Others add the cases of religious convictions and the inability resulting from his lack of specialization in treating the disease. However, considering the concept of social justice, the freedom to practice the medical profession is no longer an absolute freedom exercised in that traditional individual spirit that entitles those with free professions to practice it or refrain from practicing it as they please, which is what the researcher seeks to explain. Medicine in general is nothing but a social function in which the practitioner must seek the spirit of social solidarity. As a result of these social views, the physician must commit to performing them according to the best interests of society. The doctor is not entitled to refrain from helping or answering the call of a patient. On the other hand, the study aims to clarify that medical treatment requires the patient's consent as well. It was found that there was a difference of jurisprudence regarding this, but it does not prevent the doctor from making obligations towards the patient. While some jurists believe that the doctor or surgeon has the right to impose a medical decision whose necessity he assesses in the light of his conscience and experience, even against the will of the patient, others maintain that he cannot treat the patient without taking his free and enlightened consent. Still others see that the patient must be satisfied specifically in certain cases. In this sense, the doctor is allowed to tell white or open lies. The study concluded that the doctor must, at all stages, show the patient the feasibility of the required treatment and surgery and the extent of their success before each medical or surgical intervention. The result of the recognition of the patient’s right to maintain his physical sanctity must also work on the principle of the doctor’s obligation to provide the patient with this information and inquiries until the patient’s satisfaction comes enlightened or insightful despite the emergence of realistic problems related to obtaining the patient’s satisfaction The study generally recommends: 1- Enacting new laws that override the jurisprudential differences over consent, define its cases and arrange responsibility for it. 2- Assigning a substitute to the doctor to enlighten the patient and search for his consent in specific cases 3- Appraising the creative role of jurisprudence in the article of medical contracting and resolving the related problems.


Legal Studies ◽  
2001 ◽  
Vol 21 (4) ◽  
pp. 618-643 ◽  
Author(s):  
David Price

Recently in this journal John Keown attacked the BMA Guidance published on ‘Withholding and Withdrawing Life-prolonging Medical Treatment’, arguing that it was, fundamentally at odds with the sanctity of life doctrine as properly understood, condemning the intentional termination of individuals' lives. In riposte it is asserted that even this modified version of the doctrine cannot support a defensible moral or legal standard for decision-making here, being founded upon an excessive emphasis on the mental state of the clinician and an inappropriately narrow focus on the effects of the proposed treatment on the ‘health’ of the patient, as opposed to being primarily driven by the (best) interests of the patient. The attempt to divorce treatment decisions from broader evaluations of the net benefit or other otherwise able to be attained by the patient from such treatment, including the taking into account of the individual's handicapped state, accordingly fails. Acceptance of such reality is, at the least, the first step toward a common language for further dialogue even between those with polar opposite opinions in this sphere.


2020 ◽  
Vol 69 (4) ◽  
pp. 483-492
Author(s):  
Marko Bašković ◽  
Dora Škrljak Šoša

It is the professional responsibility of pediatric surgeons to follow the principles of maintaining life and alleviating suffering, often by questioning whether they have acted correctly. Apart from the moral dilemmas of choosing the best treatment strategies, they are often in dilemmas with the parents, who also involve their own “strategy” in the whole story, which they think is the most optimal treatment for their child, despite the contrary recommendations of the profession. Children, and especially adolescents, may be somewhat involved in medical decision making. Mostly the parent-physician-child / adolescent triangle agrees, but this is not always the case, which is why pediatric surgeons encounter problems. Ethical committees, composed of competent people, supported by the legal system of the state, who are able by consensus of team members to advocate and ensure the best interests of patients, must be activated for the full scope of the solution.


BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e026579
Author(s):  
Momoko Sasazuki ◽  
Yasunari Sakai ◽  
Ryutaro Kira ◽  
Naoko Toda ◽  
Yuko Ichimiya ◽  
...  

ObjectiveTo delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care.DesignWe conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis.ParticipantsParticipants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data.ResultsWe performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians’ convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence).ConclusionsThis is the first qualitative study to demonstrate the framework of paediatricians’ decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.


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