In theory, consent may be given by one person with parental responsibility - but when there is a dispute between parents and the treatment is not required in an emergency, it is normally appropriate to ask the parents to resolve their disagreement. For some types of treatment, agreement is required between those with parental responsibility.
What if there is a disagreement in treatment choice between parents?
However, consider the situation where there is a disagreement in treatment choice between the parent of an ill child and the physician. These disagreements often occur in cases where the prognosis for the severely ill infant or child is that they will survive, but with a poor quality of life.
What is the debate about disagreements between doctors and their parents?
It led to widespread debate about the ethics of disagreements between doctors and parents, about the place of the law in such disputes, and about the variation in approach between different parts of the world.
When does a parent have authority to make treatment decisions?
These disagreements often occur in cases where the prognosis for the severely ill infant or child is that they will survive, but with a poor quality of life. The presumption is that the parent has authority to make treatment decisions for a child when the child does not have the capacity to do so.
Can a health professional override a parent's wishes about medical treatment?
The author (s) describe an ethical framework that specifies the circumstances under which a health professional is justified in overriding a parent's wishes about a child's medical treatment The proposed framework focuses on hospital-based healthcare professionals (rather than, eg, general practitioners or school nurses)
What happens if parents disagree on medical treatment?
If your child's legal custodian refuses a life-saving or life-improving medication, surgery, vaccine, or other medical procedure and you disagree, you can petition the court for intervention.
Can parents refuse medical treatment for their child?
Parents have the responsibility and authority to make medical decisions on behalf of their children. This includes the right to refuse or discontinue treatments, even those that may be life-sustaining. However, parental decision-making should be guided by the best interests of the child.
What if parents refuse a treatment recommended by the physician?
The parent may face child abuse, child neglect, and assault charges for failing to provide the necessary medical care for their child. A conviction on these criminal charges could mean penalties like time in prison, fines, and mandated parenting classes.
Can doctors override parents decisions?
That is, because of the existence of an emergency, treatment is legally permissible, and the court does not need to adjudicate the best interest of the child in approving the physician's decision to override a parental refusal for treatment.
What course of action should be taken when two parents disagree on treatment for their child?
If you have joint legal custody and are unable to come to an agreement with the other parent, you may have to go through mediation to resolve these disagreements. Alternatively, you could agree to have a neutral third party decide for you. In drastic situations, the court may decide on your behalf.
When can the government override a parent's medical decision in the US?
If the child's parents are not acting in the best interest of their welfare, the state can override parental decisions. At the end of the day, the child's life is the primary concern. A parent can face loss of custody or criminal charges for failing to provide the necessary medical care for their child.
Why should parents make medical decisions for their child?
Introduction: Parents/legal guardians are medical decision-makers for their minor children. Lack of parental capacity to appreciate the implications of the diagnosis and consequences of refusing recommended treatment may impede pediatric patients from receiving adequate medical care.
What is a parental autonomy case?
Parental-Autonomy Doctrine refers to a principle that parents have fundamental right to raise his or her child and to make all decisions concerning that child free from governmental intervention, unless the child's health and welfare are jeopardized by the parent's decisions.
What decisions should parents make for their child?
Here are ten difficult decisions parents make to ensure their child is on the right path.Choosing a school. ... Which parent is going to stay home. ... Choosing a college out of state. ... When it's time to get a driver's license. ... Vaccinations. ... Unplugging from the internet. ... Arguments. ... Food.More items...•
What will happen if a patient's family members disagree about the care of an incapacitated patient?
When a proxy makes decisions that other parties, such as family members, disagree with, the authority of the proxy can be challenged. In order to address this issue, patients often draft a living will, which attempts to clarify the wishes of the patient.
Under what circumstances can parental consent be overridden?
A person with parental responsibility must have the capacity to give consent. If a parent refuses to give consent to a particular treatment, this decision can be overruled by the courts if treatment is thought to be in the best interests of the child.
Can you overrule doctors decision?
If you disagree with the decision then you should speak to the doctor, as you have the right to be consulted. You might not change her mind, but she should listen to you and explain the reasons for her decision. If you still disagree, then you can request a second opinion.
Joanne Houston Follow
A seriously ill child, what could be more heart breaking? But it’s even more heart breaking when parents can’t agree with the doctors about the child's medical treatment or where parents can’t agree between themselves.
The preservation of life
All steps must be taken to preserve life. But this is outweighed if quality of life is low and the pain and suffering are high.
The right to life
The child has a right to life under Article 2 of the Human Rights Act. This imposes a positive obligation to provide life sustaining treatment. But this doesn’t extend to providing treatment if it would be futile and where it would not be in the child's best interests.
The views of the parents
The Court will consider the views and opinions of the parents. But the Court will not put the parents’ wishes before the best interests of the child.
The views of the child
The views of the child must be considered depending on their age and understanding.
Guidelines of professional bodies
The Court will consider the Royal College of Paediatrics and Child Health guidance Making Decisions to Limit Treatment in Life-limiting and Life-threatening Conditions in Children: a Framework for Practice.
When Parents and Doctors Disagree About a Child's Medical Treatment
Contact Family Lawyer Joanne Houston on 01962 217640 for an initial consultation on When Parents and Doctors Disagree About a Child's Medical Treatment. In this 20 minute session she will review your situation and how you can achieve your objectives.
What are the ethical issues in pediatrics?
Conflicts between parents and health care providers are among the most common of the ethical issues encountered in pediatrics. In this article, three cases are presented along with an ethical framework for thinking about cases in which parents and providers disagree. Drawing on these cases I then provide seven strategies in the form of observations about how to understand why these conflicts occur. These strategies include the following: 1) Characterize the ethical issues correctly; most disputes are not between prioritizing the principle of respect for autonomy over the principle of beneficence, but rather differing conceptions of beneficence. 2) Recognize that the standard by which we ask that decisions be made on behalf of children is different than the standard by which we judge those decisions to be unacceptable to the point of justifying state interference. 3) “Best Interests” may not be the most appropriate standard for deciding when state action is justified; 4) the Harm Principle is more likely the appropriate principle. 5) Adolescents should be taken
Who makes health care decisions for their children?
Parents (or guardians) are generally empowered to make health care decisions on behalf of their children. In most situations, parents are granted wide latitude in the decisions they make on behalf of their children, and the law has respected those decisions except where they place the child’s health, well-being, or life in jeopardy. The best interest standard has evolved as the prevailing standard to guide surrogate decisions on behalf of another individual, and parents are expected to use the best interest standard in making decisions for their children. [7]
What was the diagnosis of Taige Mueller?
Taige Mueller was a 5-week-old with fever (101.3) brought to the emergency department (ED) for evaluation. After his examination, the ED physician’s impression was that Taige was irritable and lethargic—that she looked sick. In the physician’s judgment, based on the available literature on young infants with fever, Taige had a 3-5% risk of having a serious bacterial illness—meningitis, a bloodstream infection, or a urinary tract infection. After discussing his assessment with the parents, he recommended a typical “septic” workup—a blood draw to obtain blood, a catheterized urine collection, and a spinal tap to obtain cerebral spinal fluid. Following that, because of the infant’s young age, he also recommended treatment with antibiotics and hospitalization for at least 48 hours, at which time the results of cultures would be known. Taige’s mother consented to a partial workup, but refused the spinal tap, hospitalization, or treatment, preferring to take her baby home without treatment and return if she felt she looked more ill. Further efforts to persuade her to allow a full workup and treatment failed, so the physician involved the hospital social worker and child protective services was called. Before the night was out, Taige’s mother was restrained by police while a workup and treatment was accomplished. Eventually Taige’s parents sued the hospital and physician, claiming that the liberty interest to make decisions about the care, custody, and control of their child had been violated. [1]
What is the harm principle?
Courts place a high burden on the state to prove the medical treatment is necessary before compelling treatment over parental objections, and they have been reluctant to require medical treatment over the objection of parents “except where immediate action is necessary or where the potential for harm is rather serious.” [14] In making decisions to interfere with parental choice, child protection agencies and courts appear to use reasoning that aligns with what has become known as the “harm principle.” The harm principle was described by John Stuart Mill in On Liberty:
What is not medically indicated?
Situations in which parents request an intervention that is not medically indicated fall into a different category than those where parents withhold consent to an intervention or workup that is important to a child’s health and well-being. In this situation, there is no refusal of consent, and therefore no potential for the physician to commit battery. Unlike situations where a physician wishes to do something to a child that a parent has refused, situations where a parent requests something the physician feels is inappropriate do not require state power to limit parental choices. [22]
Should adolescents be allowed to refuse lifesaving treatment?
Most commentators agree that adolescents should be involved in discussions about their health care and should be offered the opportunity to voice their feelings, opinions, and concerns; they should be provided reasonable opportunities to make choices and have those choices respected. On the other hand, there is no consensus as to whether any adolescent is truly mature enough to refuse lifesaving treatment in situations where there is likely to be a good prognosis with a proven intervention. While adolescents above the age of thirteen are capable of making rational decisions, they are less likely to do so under conditions of high emotion or intense pressure (including peer pressure). They are more likely than adults to act impulsively without full consideration of consequences, and they weigh current rewards and harms more strongly than future consequences of a decision. An adolescent, even at seventeen, may have difficulty seeing beyond the unpleasant symptoms of a chemotherapy regimen to the long-term benefit of such treatment. Furthermore, there is good reason to question the voluntariness of an adolescent’s expressed wishes when he or she may feel pressure from parents and a church community.
Was the mother consulted before the surgery?
The mother was not consulted before the surgery was scheduled, and she objected when she learned about it. This ultimately led to a court appearance, cancellation of the initially scheduled surgery, and a second opinion from a surgeon of the mother’s choosing.
Is joint custody legal in New Jersey?
In his analysis, Judge Jones described the New Jersey policy favoring joint legal custody. In a usual case, he observed, under the New Jersey custody statute (N.J.S.A. 9:2-4), both parent’s begin with an equal right to make major decisions concerning a child’s health, education and welfare. Nevertheless, he pointed out, this arrangement is often not feasible, due to the unfortunate fact that many parents come out of acrimonious divorce proceedings with exactly the type of relationship that appeared to exist in this case. While both parents obviously loved their child, it was clear from their demeanor and body language that they neither trusted nor respected each other. The court then observed that while the statute allowed transfer of sole legal custody to either party, it also authorized “any other custody arrangement as the court may determine to be in the best interests of the child.” (N.J.S.A. 9:2-4 (c).
What is the not unreasonable standard?
Another of the less prominent frameworks is ‘the not unreasonable standard’, put forward by Rhodes and Holzman. 22 They frame their argument in terms of physicians and all surrogate decision-making. They argue that, in the paediatric context, health professionals need to assess first the appropriateness of the parents as decision-makers for the child and second the appropriateness of the parents’ actual decision. According to these authors, parents are entitled to be decision-makers only when they have ‘a commitment to the patient's well-being and [at least] a minimally appropriate level of concern [for the child]’ (p. 378). 22 Where parents fail to meet these criteria, the healthcare team should seek state involvement to appoint an appropriate surrogate decision-maker for the child. In terms of assessing the actual decision, Rhodes and Holzman argue that ‘ [i]t is critical to recognize the moral difference between a patient's decisions and a surrogate's’; patients’ are entitled to make treatment decisions based on ‘idiosyncratic’ personal reasons, whereas surrogates including parents are not (p. 383). 22 They argue that there are different types of reasons, and identify a ‘domain of judgments that are idiosyncratic or shared only by some particular social or cultural group’ (pp. 372–3). 22 They call these ‘reasons that other reasonable people could refuse’ (p. 372). 22 They argue that parental refusals of treatment based on such reasons ought to be overridden in cases when treatment is likely to bring significant benefit to the child. Their position is that ‘ [o]nly decisions based on universal reasons are acceptable for surrogate refusal of highly beneficial treatment’ (p. 383). 22
What is rational parent?
Cooper and Koch put forward a different standard based on the concept of rational decision-making: a rational parent standard would require that a parent demonstrate the ability to prioritize options for her child within the context of her own value system.
Can medical decisions be made without conflict?
In the vast majority of cases, medical treatment decisions are made for children without conflict between families and health professionals. However, in an important minority of cases, conflict arises to varying degrees. Ethicists have made a range of attempts to analyse such conflicts and to articulate the kinds of parental decisions that ought to be overridden. This paper reviews the ethical literature on conflicts between health professionals and parents about medical decision-making for children, focusing specifically on circumstances in which parents’ decisions ought to be overridden by health professionals.
Can Courts Order Families to Attend Counselling?
One issue that has recently emerged deals with the intersection of consent and the court’s practice of ordering parties in family proceedings to pursue therapy to mitigate conflict, facilitate family relationships, and ensure that parenting arrangements will meet the needs of children.
Therapeutic Orders can be Justified to Protect Families
Despite courts having jurisdiction to make therapeutic orders, is the consent of parents or children still required? For consent to be required under the HCCA before a therapeutic order can be made there must be a finding that 1) the therapeutic order constitutes “treatment”, and 2) that it is administered by a “health practitioner” as defined by the HCCA.
Giving Weight to the Views of Minor Children
The tension between the child’s best interests standard in family law, parental decision making, and the right of mature minors to make independent decisions regarding medical treatment are issues that courts continue to balance.
Assessing the Right of Mature Minors to Make Independent Treatment Choices
Courts continue to have a role assessing whether treatment accords with a child’s best interests and whether they have capacity to consent.
Contact Boulby Weinberg LLP in Toronto for Guidance on Medical Consent for Minors
The lawyers at Boulby Weinberg LLP in Toronto focus exclusively on family law matters and have experience helping clients navigate parenting matters providing the resources to make informed child-focused decisions. Our lawyers can help you with solutions tailored to your unique circumstances.
