How should others make decisions for pediatric patients?
For decades now, there has been debate in academic literature about the ethical principles that govern medical decision-making for children. In response to this, a group of leading scholars in pediatric ethics participated in a June 2022 symposium, “Best Interests and Beyond: Standards of Decision Making in Pediatrics,” at Saint Louis University. Over the course of three days, the 17 scholars debated one question – in the context of U.S. pediatric care, what moral precepts ought to guide parents and clinicians in medical decision-making for children?
The symposium and further discussions led to six recommendations for pediatric decision-making. Those findings, “Pediatric Decision Making: Consensus Recommendations,” appeared in Pediatrics on Aug. 9.
- Parents should be presumed to have wide, but not unlimited, discretion to make healthcare decisions for their children.
- Parents should protect and promote the health interests of their children while balancing practical constraints and/or other important obligations and interests.
- A clinician’s primary responsibility is to protect and promote their pediatric patients’ health interests. Clinicians’ recommendations should be informed by professional judgment and the best available evidence.
- To respect children and promote their well-being, clinicians and parents should inform pediatric patients of salient information and invite their perspective to the degree that it is developmentally appropriate.
- In addition to fulfilling state-mandated reporting requirements, clinicians should seek state intervention when all less-restrictive alternatives have failed and a parental decision places the child at significant risk of serious imminent harm or fails to meet the child’s best interests.
- Clinicians and parents should strive to collaborate in a shared decision-making process to promote the child’s interest.