Parental Rights, Best Interests and Significant Harm: Medical Decision-Making on Behalf of Children in Belgium

2020 ◽  
Author(s):  
Ingrid Boone
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Best Interests ◽  
Medical Decision ◽  
Parental Rights ◽  
Significant Harm

Bioethics in the field of pediatric surgery

2020 ◽  
Vol 69 (4) ◽  
pp. 483-492
Author(s):  
Marko Bašković ◽  
Dora Škrljak Šoša
Keyword(s):  
Decision Making ◽  
Legal System ◽  
Pediatric Surgery ◽  
Medical Decision Making ◽  
Treatment Strategies ◽  
Moral Dilemmas ◽  
The State ◽  
Best Interests ◽  
Medical Decision ◽  
Team Members

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.

scholarly journals Determining medical decision-making capacity in brain tumor patients: why and how?

2020 ◽  
Vol 7 (6) ◽  
pp. 599-612 ◽  
Author(s):  
Andrea Pace ◽  
Johan A F Koekkoek ◽  
Martin J van den Bent ◽  
Helen J Bulbeck ◽  
Jane Fleming ◽  
...  
Keyword(s):  
Decision Making ◽  
Brain Tumor ◽  
Medical Decision Making ◽  
Clinical Decision Making ◽  
Best Interests ◽  
Medical Decision ◽  
Surrogate Decision Making ◽  
Tumor Patients ◽  
Decision Making Capacity ◽  
Surrogate Decision

Abstract Background Brain tumor patients are at high risk of impaired medical decision-making capacity (MDC), which can be ethically challenging because it limits their ability to give informed consent to medical treatments or participation in research. The European Association of Neuro-Oncology Palliative Care Multidisciplinary Task Force performed a systematic review to identify relevant evidence with respect to MDC that could be used to give recommendations on how to cope with reduced MDC in brain tumor patients. Methods A literature search in several electronic databases was conducted up to September 2019, including studies with brain tumor and other neurological patients. Information related to the following topics was extracted: tools to measure MDC, consent to treatment or research, predictive patient- and treatment-related factors, surrogate decision making, and interventions to improve MDC. Results A total of 138 articles were deemed eligible. Several structured capacity-assessment instruments are available to aid clinical decision making. These instruments revealed a high incidence of impaired MDC both in brain tumors and other neurological diseases for treatment- and research-related decisions. Incapacity appeared to be mostly determined by the level of cognitive impairment. Surrogate decision making should be considered in case a patient lacks capacity, ensuring that the patient’s “best interests” and wishes are guaranteed. Several methods are available that may help to enhance patients’ consent capacity. Conclusions Clinical recommendations on how to detect and manage reduced MDC in brain tumor patients were formulated, reflecting among others the timing of MDC assessments, methods to enhance patients’ consent capacity, and alternative procedures, including surrogate consent.

Mature Minors and Parenting Disputes in Australia: Engaging with the Debate on Best Interests v Autonomy

2019 ◽  
Vol 42 (4) ◽  
Author(s):  
Lisa Young
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Children's Rights ◽  
Children’S Rights ◽  
Best Interests ◽  
Medical Decision ◽  
Decision Making Capacity ◽  
Competency Based

Australia lags behind other jurisdictions in considering the relevance of a mature minor’s decision-making capacity to parenting disputes. Gillick competency, as it is known, is routinely discussed in the case of medical decision-making, however is ignored when it comes to parenting decisions concerning very mature minors. This article explores this failure and in particular considers a) the jurisdiction of the court to determine a matter when a child is competent; b) the extent to which the courts are entitled to ignore a child’s competency, based on their best interests; c) to the extent a court should, but does not, consider a child’s competency, why they do not; and d) the arguments for overriding, or not, competency where there is a discretion. The article concludes that the court needs to reconsider this area of law, highlighting that this would play a part in the larger project of giving due recognition to children’s rights in parenting proceedings.

scholarly journals Age or maturity? African children's right to participate in medical decision-making processes

2020 ◽  
Vol 20 (2) ◽  
Author(s):  
Elvis Fokala ◽  
Annika Rudman
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Case Law ◽  
Best Interests ◽  
Medical Decision ◽  
Medical Procedures ◽  
Complex Relationship ◽  
Rights Of The Child ◽  
Decision Making Processes ◽  
Human Rights Based Approach

This article advocates an approach to children's participation in medical decision-making processes guided by the rationality of the best interests' principle, a child's evolving capacity and a child's age. Using a human rights-based approach, rooted in the UN Convention on the Rights of the Child and the African Children's Charter, it seeks to elucidate the contested three-way partnership between the child, its parent(s) and the assigned physician(s), which plays out in relation to most medical procedures involving children. In analysing legislation and case law, the article further aims to clarify the complex relationship between age and maturity in child participation; to facilitate a child's involvement in the three-way partnership; and to suggest the statutory recognition of an age indicator in domestic African law in relation to medical procedures.

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