The Patient-Parent-Pediatrician Relationship: Everyday Ethics in the Office

2015 ◽  
Vol 36 (1) ◽  
pp. 22-30
Author(s):  
John Lantos
Keyword(s):  
Corporal Punishment ◽  
Birth Control ◽  
Child Protection ◽  
Drug Testing ◽  
Home Birth ◽  
Parental Choice ◽  
Vaccine Hesitancy ◽  
Mothers And Fathers ◽  
Medical Interventions ◽  
Everyday Ethics

Pediatricians and parents generally try to do what is best for children, but they do not always agree about what that is. Mothers and fathers may disagree with each other. Parents may disagree with pediatricians. Disagreements can arise about the goals, nature, and value of communication with children about health information. Disagreements can arise over the value of particular medical interventions. Some disagreements are grounded in different religious beliefs. Some are about moral values. Some are disagreements about ends, others about the best means to an agreed on end. If there is an intractable disagreement and discussion has failed to resolve that disagreement, pediatricians must decide whether to compromise their own values to preserve a therapeutic relationship, sever that relationship, or try to override a parental choice by referring a case to child protection authorities. Most cases can be resolved and a consensus found. This article discusses some common scenarios in which disagreements arise, including home birth, refusal of vitamin K, vaccine hesitancy, birth control for teens, corporal punishment, and surreptitious drug testing.

Buprenorphine not detected on urine drug screening in supervised treatment

2021 ◽  
Vol 17 (7) ◽  
pp. 69-76
Author(s):  
Nazila Jamshidi, MBBS, FRACP, FAChAM, BPharm (hons), PhD ◽  
Akshay Athavale, MBBS, FRACP, BPharm (hons), MMed ◽  
Bridin Murnion, MBChB, FRACP, FFPMANZCA, FAChAM
Keyword(s):  
Cytochrome P450 ◽  
Child Protection ◽  
Drug Testing ◽  
Addiction Treatment ◽  
Clinical Decision ◽  
Gas Chromatography Mass Spectrometry ◽  
Cytochrome P450 3A4 ◽  
Opioid Agonist ◽  
Detection Rates ◽  
Urine Drug

Introduction: Urine drug screens (UDS) assist in clinical planning and assessment of adherence in opioid agonist treatment (OAT). Urine drug screens may also be used in criminal justice and child protection settings. Buprenorphine (BPN) UDS testing is complex. Immunoassay often does not detect BPN and gas chromatography-mass spectrometry (GC-MS) is needed. A limited understanding of testing can negatively influence UDS interpretation and clinical decision making.Objectives: The primary aim was to determine detection rates of BPN in UDS in participants on BPN or buprenorphine/naloxone (BNX) treatment. The secondary aim was to identify if comorbidities, sex, co-prescribed medications, or dosing site and observation were associated with BPN detection.Setting: Public outpatient clinic in a specialist addiction treatment service.Design/participants: In this retrospective observational study, records of clients on supervised BPN/BNX treatment between September 2017 and 2018 were reviewed.Measures: Data extracted included UDS results, age, sex, indication for BPN, frequency of observed doses, dose of BPN, dosing site, co-morbid medical conditions, and medications.Results: One hundred and sixty-one medical records were reviewed. Ninety-seven (60 percent) underwent screening urine immunoassay. Of these 97, 51 (53 percent) had further GC-MS testing for BPN of which 22 (43 percent) did not detect BPN despite directly observed OAT. Co-prescription of medications known to interact with cytochrome P450 3A4 was associated with nondetection of BPN (p 0.05). No significant association between median dose, dosing site, and observed dosing and BPN detection was identified.Conclusion: Urine drug testing for BPN is complex. Failure to detect BPN does not betoken nonadherence to treatment and is associated with co-prescription of drugs interacting with cytochrome P450 3A4.

The Child’s Right to Be Vaccinated

2021 ◽  
Vol 29 (4) ◽  
pp. 897-919
Author(s):  
Katherine Hunt Federle
Keyword(s):  
Public Safety ◽  
The State ◽  
Parental Choice ◽  
Vaccine Hesitancy ◽  
Individual Welfare ◽  
The Law ◽  
The Individual

Abstract Vaccine hesitancy highlights a problem within current rights constructs under US law. Refusal to vaccinate is ineluctably cast as a contest between parental choice, to which the law traditionally defers, and state concerns for public safety and the individual welfare of children. But rarely is the discussion cast in terms of the child’s right to be vaccinated because our rights talk revolves around the capacity (or lack thereof) of the rights holder. If, however, we recast rights in terms of empowerment, then we can see that rights flow to the child, not because she has the requisite capacity but because she is less powerful. In this sense, rights exist for children because they are children. The authority of the state to mandate immunisation under US law also may be reconsidered because the state is acting to protect the rights of those less powerful – the children who cannot be vaccinated.

Child Protection through the Criminal Law

2020 ◽  
pp. 85-114
Author(s):  
Kenneth McK. Norrie
Keyword(s):  
Corporal Punishment ◽  
Criminal Law ◽  
Child Protection ◽  
Adult Population ◽  
Common Law ◽  
Legal Basis ◽  
Sexual Offences ◽  
The Common ◽  
The Law ◽  
A Charge

The earliest criminal law dealing with children differently from the adult population was that concerned with sexual offences. This chapter explores the changing policies of the law, from the late 19th century fear of girls being exposed to immorality and boys being exposed to homosexuality, through the more protective 20th century legislation which nevertheless hung on to old ideas of immorality and criminality, until the Sexual Offences (Scotland) Act 2009 focused almost (but not quite) exclusively on protection from harm and from exploitation. The chapter then turns to the crime of child cruelty or neglect from its earliest manifestation in the common law to its statutory formulation in Prevention of Cruelty to, and Protection of, Children Act 1889, which, re-enacted in 1937, took on a form that, for all intents and purposes, remains to this day. The last part of the chapter explores the legal basis for the power of corporal punishment – the defence previously available to parents, teachers and some others to a charge of assault of a child, known as “reasonable” chastisement. Its gradual abolition from the 1980s to 2019 is described.

scholarly journals Severity and justness do not moderate the relation between corporal punishment and negative child outcomes

2017 ◽  
Vol 41 (4) ◽  
pp. 491-502 ◽  
Author(s):  
Liane Peña Alampay ◽  
Jennifer Godwin ◽  
Jennifer E. Lansford ◽  
Anna Silvia Bombi ◽  
Marc H. Bornstein ◽  
...  
Keyword(s):  
Corporal Punishment ◽  
Child Outcomes ◽  
Positive Association ◽  
The United States ◽  
Internalizing Behavior ◽  
Cultural Groups ◽  
Child Behaviors ◽  
Mothers And Fathers ◽  
Child Problem Behavior ◽  
One Year

There is strong evidence of a positive association between corporal punishment and negative child outcomes, but previous studies have suggested that the manner in which parents implement corporal punishment moderates the effects of its use. This study investigated whether severity and justness in the use of corporal punishment moderate the associations between frequency of corporal punishment and child externalizing and internalizing behaviors. This question was examined using a multicultural sample from eight countries and two waves of data collected one year apart. Interviews were conducted with 998 children aged 7–10 years, and their mothers and fathers, from China, Colombia, Italy, Jordan, Kenya, Philippines, Thailand, and the United States. Mothers and fathers responded to questions on the frequency, severity, and justness of their use of corporal punishment; they also reported on the externalizing and internalizing behavior of their child. Children reported on their aggression. Multigroup path models revealed that across cultural groups, and as reported by mothers and fathers, there is a positive relation between the frequency of corporal punishment and externalizing child behaviors. Mother-reported severity and father-reported justness were associated with child-reported aggression. Neither severity nor justness moderated the relation between frequency of corporal punishment and child problem behavior. The null result suggests that more use of corporal punishment is harmful to children regardless of how it is implemented, but requires further substantiation as the study is unable to definitively conclude that there is no true interaction effect.

scholarly journals Reflexivity in correctional research: Researcher perspectives on parenthood in a study with incarcerated parents

2018 ◽  
Vol 19 (1) ◽  
pp. 56-74
Author(s):  
Chris Rossiter ◽  
Tamara Power ◽  
Cathrine Fowler ◽  
Koby Elliott ◽  
Angela Dawson
Keyword(s):  
Child Protection ◽  
Life Experiences ◽  
Incarcerated Mothers ◽  
Incarcerated Parents ◽  
Mothers And Fathers ◽  
Critical Reflexivity ◽  
Parents And Children ◽  
Health Practitioners ◽  
Correctional Settings ◽  
Conducting Research

As incarceration rates rise worldwide, increasing numbers of parents are separated from their children. Researchers have studied the psychosocial impact on inmates and their families extensively. However, few researchers have examined how their own perspectives affect the collection and interpretation of data, specifically about parenting in correctional settings. This paper consider methodological implications of conducting research with incarcerated mothers and fathers, employing critical reflexivity to explore researchers’ individual and collective experiences in a study in Australian correctional facilities. Using ourselves as informants, we examine how the context and life experiences of ‘researcher’ and ‘researched’ interact during interviews in a unique and emotionally charged environment. Correctional research requires careful adaptations to collect meaningful data from inmates and recognise their vulnerability as parents. The emotional content of interviews also has implications for analysing and interpreting research data. Our focus on interviewees as mothers and fathers, rather than as offenders, generated greater understanding of the needs of parents in custody. Recognising researchers’ feelings, experiences and perspectives on parenthood can enrich research with families affected by the criminal justice and child protection systems. These insights can also inform the understanding and practice of social workers, health practitioners, educators and students who work with marginalised parents and children.

Sudden severe fetal compromise at a planned home birth – a case of umbilical cord prolapse

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Amos Grünebaum ◽  
Laurence B. McCullough ◽  
Frank A. Chervenak ◽  
Joachim W. Dudenhausen
Keyword(s):  
Umbilical Cord ◽  
Neonatal Resuscitation ◽  
Home Birth ◽  
Medical Interventions ◽  
Risk Patients ◽  
Cord Prolapse ◽  
Neonatal Injury ◽  
Planned Home Birth ◽  
Umbilical Cord Prolapse ◽  
Fetal Compromise

Abstract Background Sudden severe fetal compromise during labor is usually associated with fetal bradycardia often due to sudden emergencies such as abruptio placentae, cord prolapse, disruption of the umbilical cord, shoulder dystocia, tetanic contractions or uterine rupture. Case presentation We report on a case of sudden severe fetal compromise due to umbilical cord prolapse in a patient with a planned home birth. Cord prolapse and thick meconium stained fluid were diagnosed at a planned home birth at the time of spontaneous rupture of fetal membranes with the cervix 3 cm dilated. An ambulance was called, and the patient was transferred by ambulance to the nearby hospital where the baby was delivered about 60 min after the diagnosis of the cord prolapse. Neonatal resuscitation was unsuccessful, and the newborn was declared dead. Conclusion Our case shows that sudden severe fetal compromise during labor and delivery can happen to even low-risk patients. When it happens at home, delay of delivery can lead to neonatal injury or death. Women who express an interest in a planned home birth must be informed of potential risks of sudden severe fetal compromise leading to neonatal injury or death when it occurs in a planned home birth and when transport to the hospital unavoidably delays timely medical interventions and delivery of the newborn.

Parents’ Experiences and Nurses’ Perceptions of Decision-Making About Childhood Immunization

2019 ◽  
pp. 084456211984734 ◽  
Author(s):  
Sharolyn Mossey ◽  
Shelly Hosman ◽  
Phyllis Montgomery ◽  
Karen McCauley
Keyword(s):  
Professional Development ◽  
Decision Making ◽  
Social Media ◽  
Clinical Setting ◽  
Child Protection ◽  
Vaccine Hesitancy ◽  
Childhood Immunization ◽  
Nursing Curricula ◽  
Nurses Perceptions ◽  
Parents Experiences

Background Immunization in Canada is recommended not mandated, granting parents discretionary decision-making power regarding their child’s immunization status. Uptake of childhood immunization at present falls below national targets. Nurses who interact with parents in the clinical setting may witness parents’ decision-making experiences, attitudes, and opinions inclusive of vaccine hesitancy. Purpose The aim of this study is to understand parents’ and nurses’ experiences of decision-making about childhood immunization, specifically measles-mumps-rubella and/or diphtheria-tetanus-acellular pertussis. Methods Thorne’s interpretative description approach was used to understand parents’ and nurses’ experiences and perspectives about immunization. The sample was 6 nurses and 16 parents residing in northeastern Ontario. Results Common to all participants was the goal of protection. Motivated by child protection, parents carried out three broad actions, searching for information, deliberating the information and sources to determine the relative benefits and risks of immunization, and bearing responsibility for their decision to accept, delay, or decline immunization. Nurses were motivated by child protection and population health. Conclusion Implications for nursing included integration of immunization competencies in nursing curricula, ongoing professional development, validation of parental actions for child protection, nurse-led education sessions, and engaging parents through social media to support access to reputable information.

Beating Children Is Wrong, Isn't It? Resolving Conflicts in the Encounter Between Religious Worldviews and Child Protection

2013 ◽  
Vol 15 (2) ◽  
pp. 130-143 ◽  
Author(s):  
Catherine Shelley
Keyword(s):  
Cultural Differences ◽  
Religious Education ◽  
Corporal Punishment ◽  
Religious Belief ◽  
Child Protection ◽  
Forced Marriage ◽  
Religious Difference ◽  
Honour Killing ◽  
Religious Worldviews

Responding to the death of Victoria Climbié in 2003, the Laming Report stated that cultural differences should never again be a factor in inadequate child protection. Yet since that time there have been further deaths of children involving exorcism and allegations of witchcraft, based in part on particular understandings of Christianity. Situations resulting in forced marriage, cliterodectomy, ‘honour’ killing and corporal punishment are practices often perceived as arising from religious belief, both by those who defend them and by critics. This article explores practices perceived as grounded in religious belief or culture that conflict with current child protection practice and norms about what is harmful to children. The role of religious education, rights to manifest religious belief and different understandings of adoption are also considered as examples of religious difference in understandings about children. Engagement with religious difference through a defence of children's rights and autonomy are proposed as one means to resolve conflicts between religious worldviews and what it means to protect children. The aim is to identify and foster reflection and debate about different understandings of what constitutes harm, in order to enhance consensus over child protection where views of what is harmful differ radically.1

scholarly journals Looking at and seeing beyond young people’s photographs of ‘child protection’ in Zanzibar

2019 ◽  
Vol 6 (4) ◽  
Author(s):  
Franziska Fay
Keyword(s):  
Young People ◽  
Corporal Punishment ◽  
Child Protection ◽  
Visual Representations ◽  
Well Being

In this think piece, I argue that making children diagnosticians of their own well-being can contribute to a broader understanding of child protection that goes beyond singular issues like corporal punishment. Children themselves are well placed to help define what their protection needs to entail and what is essential to their own well-being. What child protection means to children themselves is best understood by granting young people authority to explain their own lives, while also relating their concerns to the broader contexts in which they live. By means of some Zanzibari young people’s visual representations of protection and safety, I emphasise the need to ‘see beyond’ their photographs and ‘read’ them alongside their own explanations. Their accounts ultimately build a case for the need to broaden understandings of ‘protection’ to include ideas of promoting well-being.

Sign in / Sign up

Export Citation Format

Share Document