Ethics in Pediatric Medical Decisions
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What ethical consideration is primarily raised by the situation of the 7-year-old girl with end-stage cancer whose parents insist on resuscitative therapies?

  • The legality of stopping chest compressions
  • The child's right to refuse treatment
  • The necessity of mechanical ventilation in all cases
  • The parents' autonomy in decision-making (correct)

    • In the case of the 15-year-old Jehovah’s Witness, what principle is challenged regarding medical treatment?

  • Cultural beliefs can influence medical ethics (correct)
  • Emergency treatment must always override personal beliefs
  • All patients must accept blood products for survival
  • Autonomy of the patient is absolute

    • In the scenario of the 12-year-old boy with cancer, what cultural factor complicates the truth-telling in medical practice?

  • The potential for family conflict over the diagnosis
  • The child's age and understanding of his condition
  • The father's belief in parental duty to shield their child from pain (correct)
  • The overwhelming clinical evidence of the prognosis

    • Which ethical question arises regarding the obligation to provide food and water to a child in medical care?

    <p>Does withholding food and water represent ethical neglect?</p> Signup and view all the answers

    What is a significant concern in the context of the debate over resuscitative therapies for critically ill children?

    <p>The ethical implications of life-sustaining treatments against the wishes of the child</p> Signup and view all the answers

    What is the primary ethical consideration when making treatment decisions for children?

    <p>The child’s best interests must be prioritized.</p> Signup and view all the answers

    Which population is considered particularly vulnerable due to socio-economic factors?

    <p>Children with mental health concerns</p> Signup and view all the answers

    What role can parents typically play in healthcare decision making for their children?

    <p>They act as appropriate surrogate decision makers.</p> Signup and view all the answers

    In pediatric palliative care, what is a significant challenge faced in decision-making?

    <p>Balancing parental input with professional recommendations.</p> Signup and view all the answers

    Which of the following is an ethical challenge that may arise when a child wishes to keep information private?

    <p>Assessing the child's developmental stage and maturity.</p> Signup and view all the answers

    Which criterion is emphasized as important for determining whether to provide therapy to a child?

    <p>The child’s own voice and wishes.</p> Signup and view all the answers

    What best describes children’s overall legal position when it comes to pursuing their rights?

    <p>Children require a surrogate to advocate for them.</p> Signup and view all the answers

    Which of the following groups is specifically recognized as multiply vulnerable?

    <p>Children experiencing low income or poverty.</p> Signup and view all the answers

    What is the primary factor that determines a minor's healthcare decision-making capacity?

    <p>The minor's evolving maturity</p> Signup and view all the answers

    What does the concept of child assent imply in healthcare decision-making?

    <p>Children's understanding of their conditions should be optimized</p> Signup and view all the answers

    How should healthcare professionals approach children who have difficulty expressing their voices?

    <p>By employing innovative communication strategies</p> Signup and view all the answers

    What ethical challenge relates to the confidentiality of pediatric care?

    <p>Balancing confidentiality between children and parents</p> Signup and view all the answers

    According to the Canadian Pediatric Society, what is essential in providing information to patients and their families?

    <p>It should be truthful, clear, and sensitive</p> Signup and view all the answers

    What is a critical aspect of respecting children's privacy in healthcare practice?

    <p>Confidentiality must be upheld while also including parents</p> Signup and view all the answers

    What role do parents play in the communication of healthcare decisions for children?

    <p>Parents can help translate children's voices</p> Signup and view all the answers

    What is the main concern when listening to children without consenting capacity?

    <p>They need to be respected as individuals</p> Signup and view all the answers

    What is a condition that must be met to justify high dose sedation in palliative care?

    <p>The nature of the act must be morally neutral or good.</p> Signup and view all the answers

    Which of the following is NOT a condition for ethically justifying the use of high dose sedation?

    <p>The situation must be non-life-threatening.</p> Signup and view all the answers

    What stance is taken on withdrawing artificial nutrition and hydration in pediatric care?

    <p>It is legally and ethically permissible when it's in the child's best interest.</p> Signup and view all the answers

    What is a misconception regarding the intention behind high dose sedation?

    <p>Death should be seen as a primary goal.</p> Signup and view all the answers

    What should be considered when deciding to withdraw artificial nutrition and hydration from a pediatric patient?

    <p>The best interest of the child must be evaluated.</p> Signup and view all the answers

    What are major unmet needs of disabled children linked to?

    <p>Serious health and social consequences</p> Signup and view all the answers

    Which group of children is noted to have inadequate access to health and social services?

    <p>Migrant newcomer children</p> Signup and view all the answers

    What is one of the ethical challenges faced in pediatric palliative care?

    <p>Administering medications that may shorten life</p> Signup and view all the answers

    Under what circumstance can exceptions to the duty to provide life-sustaining treatment be made?

    <p>When there is consensus on irreversible imminent death</p> Signup and view all the answers

    Which principle allows for actions with both good and bad consequences in pediatric palliative care?

    <p>Principle of double effect</p> Signup and view all the answers

    What has been amplified during the COVID-19 pandemic according to the noted issues?

    <p>Inequities in child health</p> Signup and view all the answers

    Which condition is not noted as a serious health risk for Indigenous children?

    <p>Increased rates of obesity</p> Signup and view all the answers

    What limitation in pediatric palliative care can allow for better palliative treatment?

    <p>Limitation allows greater palliative care</p> Signup and view all the answers

    Which of the following accurately reflects the legal status of Medical Aid in Dying for minors in Quebec?

    <p>It is not permissible for minors.</p> Signup and view all the answers

    What right is explicitly recognized for minors under the 'An Act respecting end-of-life care'?

    <p>The right to palliative sedation.</p> Signup and view all the answers

    In the context of pediatric palliative care, what is the primary role of healthcare providers regarding children's voices?

    <p>To include children's concerns and recognize them as moral agents.</p> Signup and view all the answers

    What does the term 'Participatory Models' refer to in the context of pediatric ethics?

    <p>Engaging young people in discussions about their concerns and rights.</p> Signup and view all the answers

    What is NOT a key feature of the 'An Act respecting end-of-life care' in Quebec relevant to minors?

    <p>Legalization of euthanasia.</p> Signup and view all the answers

    What is an important consideration in ethics discussions when caring for young patients?

    <p>Incorporating the perspectives and values of the nursing team.</p> Signup and view all the answers

    How does the Hermeneutical Rapprochement Framework assist in pediatric ethics?

    <p>By facilitating understanding of diverse socio-historical perspectives.</p> Signup and view all the answers

    What critical element should be recognized when addressing children's rights in healthcare decisions?

    <p>The significance of children's interests and agency.</p> Signup and view all the answers

    Which of the following statements about palliative care for minors is accurate?

    <p>Palliative care can compromise vital signs but is legal for minors.</p> Signup and view all the answers

    What is a significant outcome of recognizing young people's agency in an ethical context?

    <p>Improved inclusion of children's perspectives in policy-making.</p> Signup and view all the answers

    What does the term 'tragic choices' refer to in pediatric critical care?

    <p>Choosing among options that all have negative consequences</p> Signup and view all the answers

    How can environmental factors impact disabled children according to the content?

    <p>They can disable children if changes are not made to improve accessibility.</p> Signup and view all the answers

    What common outcome arises from ethical dilemmas in pediatric critical care?

    <p>Relational tensions and conflict between stakeholders</p> Signup and view all the answers

    What is commonly misunderstood about the quality of life of disabled children?

    <p>Their lives are often viewed as less valuable than those without disabilities.</p> Signup and view all the answers

    What ethical challenge does the notion of 'moral distress' primarily address in pediatric nursing?

    <p>The emotional conflict experienced when one is unable to act according to their values.</p> Signup and view all the answers

    What is a vital consideration when determining the best interests of a child in medical decision-making?

    <p>The child's intrinsic value and dignity</p> Signup and view all the answers

    Which group is noted as particularly vulnerable due to cultural and social factors?

    <p>Migrants and Indigenous children</p> Signup and view all the answers

    Which ethical challenge is typically encountered when there are conflicting opinions between parents and healthcare providers?

    <p>Ensuring confidentiality of the child's wishes</p> Signup and view all the answers

    What role do parents typically hold in healthcare decisions for their children according to pediatric ethical norms?

    <p>Appropriate surrogate decision-makers prioritizing the child’s interests</p> Signup and view all the answers

    Which ethical norm emphasizes the significance of the child's voice in treatment decisions?

    <p>The voice of the child should be included wherever possible</p> Signup and view all the answers

    What primary concern is raised in pediatric palliative care when discussing a child’s prognosis?

    <p>The possibility of severe unintended consequences</p> Signup and view all the answers

    What is a common misconception regarding the decision to withdraw artificial nutrition and hydration in pediatric care?

    <p>Withdrawing care is equated with euthanasia</p> Signup and view all the answers

    What is emphasized as critical in ensuring that children's rights are respected in healthcare decisions?

    <p>Children's intrinsic value and dignity must be recognized</p> Signup and view all the answers

    What is the role of parents regarding consent for healthcare decisions for minors under the Civil Code of Quebec?

    <p>A minor 14 years or older can give consent independently.</p> Signup and view all the answers

    How does the presumption of capacity apply to minors in healthcare decision-making?

    <p>Minors may be capable regarding some treatments while incapable regarding others.</p> Signup and view all the answers

    What concept suggests that children should be involved in healthcare decisions affecting them?

    <p>Child Assent</p> Signup and view all the answers

    Under the Health Care Consent Act (Ontario), what is necessary for a person to be deemed capable of making treatment decisions?

    <p>Understanding relevant information and its outcomes.</p> Signup and view all the answers

    What is a major ethical challenge in considering the voice of children in healthcare?

    <p>Healthcare professionals often prioritize parental authority over child's voice.</p> Signup and view all the answers

    What is the implication of benevolent medical paternalism in pediatric healthcare?

    <p>It allows healthcare providers to make decisions believed to be in the best interest of the child.</p> Signup and view all the answers

    What aspect of child agency is increasingly recognized in the decision-making process in healthcare?

    <p>Children's voices should be integrated into the consent process.</p> Signup and view all the answers

    What does the term 'voice of the child' signify in the context of pediatric healthcare?

    <p>The acknowledgment and consideration of children's preferences and feelings.</p> Signup and view all the answers

    What are the conditions under which confidentiality may be breached in pediatric care?

    <p>Client consent, serious bodily harm risk, public interest</p> Signup and view all the answers

    In pediatric care, what is a critical condition that requires consideration before disclosing sensitive information?

    <p>Clear risk to identifiable persons</p> Signup and view all the answers

    Which ethical consideration may arise regarding the treatment of newborns with severe health issues?

    <p>Standards for limiting treatment based on the newborn's potential</p> Signup and view all the answers

    What is a potential misconception surrounding the treatment of premature babies compared to older children?

    <p>They are often viewed as having a lesser moral status</p> Signup and view all the answers

    When a child expresses a desire for confidentiality around healthcare decisions, what ethical challenge arises?

    <p>Balancing the child's autonomy with parental rights</p> Signup and view all the answers

    What is considered an imminent danger in the context of pediatric confidentiality exceptions?

    <p>Imminent risk of serious bodily harm or death</p> Signup and view all the answers

    What factor can create ethical dilemmas when treating children with long-term disabilities?

    <p>The child's potential for normalcy over time</p> Signup and view all the answers

    Which principle is often debated in the context of pediatric palliative care regarding actions that may have both beneficial and harmful consequences?

    <p>Principle of double effect</p> Signup and view all the answers

    What is a condition under which life-sustaining treatment may be ethically withheld in pediatric care?

    <p>There is consensus on irreversible imminent death.</p> Signup and view all the answers

    What principle allows for actions that may have both beneficial and harmful consequences in pediatric palliative care?

    <p>Principle of double effect</p> Signup and view all the answers

    In pediatric palliative care, what ethical question arises regarding the use of palliative sedation?

    <p>Is it permissible to intentionally shorten life?</p> Signup and view all the answers

    What major issue has been exacerbated during the COVID-19 pandemic regarding children?

    <p>Amplified inequity in health access.</p> Signup and view all the answers

    Which group of children has been identified as having serious health risks including increased rates of infant mortality?

    <p>Indigenous children</p> Signup and view all the answers

    Under which situation can exceptions to the duty to provide life-sustaining treatment be justified?

    <p>When treatment is deemed to be ineffective or harmful.</p> Signup and view all the answers

    What is one of the major unmet needs affecting disabled children?

    <p>Comprehensive healthcare services</p> Signup and view all the answers

    What consequence is associated with poverty in the context of children's healthcare and technology access?

    <p>Increased physical health issues</p> Signup and view all the answers

    What is a key feature of 'An Act respecting end-of-life care' in Quebec for minors?

    <p>It permits palliative sedation for minors.</p> Signup and view all the answers

    Which aspect of child rights is emphasized in nursing regarding children's voices?

    <p>Children are acknowledged as moral agents with their own views and concerns.</p> Signup and view all the answers

    In the context of pediatric palliative care, what role does the Hermeneutical Rapprochement Framework play?

    <p>It offers a method for reconciling differing ethical views.</p> Signup and view all the answers

    What is NOT a feature of the legal framework surrounding Medical Assistance in Dying for minors?

    <p>It permits children under 18 to choose euthanasia.</p> Signup and view all the answers

    What is a common misconception regarding pediatric palliative care?

    <p>Palliative sedation is intended to hasten death.</p> Signup and view all the answers

    Which strategy emphasizes the importance of children's involvement in policy-making?

    <p>Participatory models advocate with children, respecting their agency.</p> Signup and view all the answers

    Which of the following best describes the legal status of advance medical directives for minors in Quebec?

    <p>Advance medical directives are legalized but only applicable to adults.</p> Signup and view all the answers

    What ethical issue arises when discussing the role of nursing in children's healthcare?

    <p>Nurses must evaluate and participate in ethical discussions actively.</p> Signup and view all the answers

    What is a primary consideration regarding children's rights in healthcare decisions?

    <p>Children's concerns and interpretations must be included in decisions.</p> Signup and view all the answers

    How should nurses approach ethical dilemmas in pediatric palliative care?

    <p>Actively identify and address key ethical concerns in collaboration with the team.</p> Signup and view all the answers

    Study Notes

    Childhood Ethics

    • Franco A. Carnevale is a nurse, psychologist, clinical ethicist, full professor, and principal investigator at McGill University.
    • He has expertise in children and youth.
    • He's involved in interdisciplinary childhood ethics research and has a website and Twitter account (@childethics).
    • He researches at Douglas Mental Health University Institute, Le Phare, Shriner's Hospitals for Children (Canada), Montreal Children's Hospital - MUHC.

    Resuscitative Therapies

    • A 7-year-old girl with end-stage cancer was admitted to the PICU.
    • Her parents insisted on life-sustaining treatment including mechanical ventilation and high-dose inotropic support.
    • Skin breakdown and hemodynamic instability occurred.
    • Parents objected to limiting chest compressions.

    Religious Beliefs & Clinical Practices

    • A 15-year-old with multiple trauma was a Jehovah's Witness, refusing blood products along with her mother.
    • Hemodynamic instability was present.
    • Hemoglobin (Hgb) levels were 85…35.

    Should the Truth Be Told?

    • A 12-year-old boy with metastasized cancer required surgery, radiotherapy, and chemotherapy.
    • His prognosis was severely guarded.
    • The father was against disclosing the diagnosis/prognosis to the boy.
    • His family's cultural norms indicated this was a burden for the parents.

    Basic Obligation to Provide Food & Water

    • A 3-year-old girl underwent a tonsillectomy and adenoidectomy (T&A).
    • She suffered severe hemorrhage overnight, cardiopulmonary arrest, and severe brain injury.
    • Two weeks later, she was breathing spontaneously, had severe neurological injury, and a severe disability was projected, requiring at least one month to confirm.
    • Parents insisted on discontinuing nutrition/hydration.

    Children's Vulnerability

    • Children are disadvantaged physically, psychologically, socially, and legally.
    • Socially, they have difficulty discerning who to trust.
    • Legally, they cannot independently pursue their rights.

    Multiply Vulnerable Children

    • Examples of particularly vulnerable children include disabled children, those with mental health concerns, LGBTQ2A youth, newborns, Indigenous children, migrant newcomers, those experiencing low income/poverty, cultural/religious/racial diversity, child welfare (youth protection) issues, pediatric palliative care, and global child health concerns.

    Nursing Children & Families: Ethical Challenges

    • The criteria for providing therapies need to be established.
    • Decision-making roles need to be identified.
    • Children's perspectives need to be incorporated.
    • Confidentiality considerations, particularly between children and parents and among team members, and within pediatric palliative care need to be addressed.
    • Additional challenges within pediatric palliative care need more discussion.

    Pediatric Ethical Norms (Canada)

    • All infants, children, and adolescents have dignity, intrinsic value, and a claim to respect, protection, and appropriate medical treatment.
    • Parents are often appropriate surrogate decision makers for children.
    • Children and adolescents should be involved in decisions affecting them and once they develop sufficient decision-making capacity, they should be the principal decision-makers for themselves.

    Medical Decision-Making in Pediatrics

    • Children and adolescents' participation in medical decisions should align with their developmental stage.
    • Healthcare professionals and surrogate decision-makers should be adequately informed by laws and regulations.
    • Patient's best interests and outcomes should guide decisions.
    • Disagreements or conflicting interests necessitate collaborative processes and identified surrogate decision-makers.
    • HCPs need to use conflict resolution processes to resolve conflicts and help patients/families access resources to resolve issues.

    Criteria for Therapies

    • The 'Child's Best Interests' must be considered alongside assessing benefits and burdens.
    • The balance between prolonging life and quality of life needs careful consideration.

    Who Should Decide Treatment?

    • Healthcare professionals have a duty to work toward the patient's best interest.
    • Decisions on significant care issues such as CPR or cancer treatment may be made by physicians using benevolent medical paternalism.
    • Parents generally are significant agents for children; family autonomy is important.
    • The child should be engaged based on capacity.
    • Other individuals might contribute depending on the circumstances.

    What about the Child's Voice?

    • Recognizing a child's voice is crucial, even without legal decision-making capacity.
    • Child's moral agency must be respected.
    • Optimize assent by ensuring the child understands their condition, the proposed treatment, and the associated circumstances.
    • Seek the child's voluntary cooperation wherever possible.
    • Different jurisdictions have varying legal standards for minors' consent to treatment.
    • Consent/permission exceptions exist for mature minors, emancipated minors, situations requiring emergency treatment, and court-ordered interventions.

    "Mature Minor" in Canada

    • "Mature Minor" isn't a universally defined term in Canadian law.
    • Decision-making capacity is rooted in the child's maturity rather than solely their age.
    • Minors' participation should align with their expressed ability and age-appropriate understanding.

    Listening to Children's Voices

    • Children with communication difficulties require specialized methods.
    • Parents may help interpret their children's needs, facilitating a shared understanding within professional teams.

    Confidentiality

    • Confidentiality may be breached in cases when the patient presents an imminent threat to self or others. Specific conditions exist (i.e., immediate danger, harm to self or others).
    • Disclosure should be limited to the specific risk and not go beyond what's necessary to manage the risk.

    Confidentiality Conditions for Disclosure

    • Conditions requiring disclosure include a clear risk to an identifiable person or group, serious risk of bodily harm or death, and imminent danger.

    Special Considerations for Newborns

    • Additional care should be implemented, understanding that newborns are children.
    • Determining if similar care practices and considerations apply need careful planning.

    Excessive & Dismissive Practices

    • Recognize that newborns are children with inherent needs for protection and care..
    • Evaluate if newborns experience disparities compared to older children with similar prognoses requiring attention to disparities in care.

    Long-Term Disability

    • Long-term disability requires a holistic approach, and all factors for the child's well-being need to be considered.

    Daily Living With Distress

    • Families caring for ventilator-supported children face immense physical and emotional distress.
    • Support systems and services must adapt to the child's needs and the family's context.

    Quality of Life

    • Evaluate the quality of life for disabled children, recognizing their unique ways of experiencing life.

    Critical Illness

    • Pediatric critical care environments present unique challenges due to often uncertain diagnoses, prognoses, and tragic choices.
    • Resolution of disagreements, conflicts, and common moral distress must be addressed.

    Inequities

    • Recognize existing healthcare disparities across different child populations based on various factors (disability, hunger, migrant status, Indigenous background).
    • Addressing unjust circumstances is vital for equitable healthcare systems.

    Pediatric Palliative Care

    • Ethical considerations for life-sustaining treatment (e.g., nutrition, hydration), appropriateness of medications that impact life expectancy, and end-of-life care require specific attention to children's unique needs.

    Medical Assistance in Dying

    • Euthanasia is not legal for children, however, societal contexts impact ethical considerations.
    • Quebec's Act respecting end-of-life care (Bill 52) may have specific considerations regarding end-of-life issues. Consideration must be given to minors. Appropriate legal frameworks should be consulted to discuss ethical issues and conflicts surrounding end-of-life, euthanasia, and palliative care.

    Listening to Children's Voices

    • Child-centered considerations including children's rights, evidence, clinical evidence, research must be addressed.
    • Children's active participation is vital in governance and policy-making.

    Strategies for Reconciliation

    • Proactive ethics-based discussions for nursing teams are useful.
    • Ongoing ethics education, consultations, and multidisciplinary teamwork are vital for ethical decision-making and practice.

    Hermeneutical Rapprochement Framework

    • The hermeneutical framework aids in understanding situations through the lenses of societal factors, values, and needs of children.
    • It facilitates a deeper understanding of the historical and sociocultural contexts, including political implications.
    • This approach leads to a reconciliation between divergent perspectives.

    Listening to Children's Voices

    • Strategies are necessary when children's voices are difficult to access. Specialized communication and interpretation methods are required.

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    Childhood Ethics PDF - McGill

    Description

    This quiz explores the ethical considerations involved in pediatric medical decision-making, focusing on cases of critically ill children. It addresses dilemmas faced by healthcare providers and families, including issues related to resuscitative therapies, truth-telling, and the role of socio-economic factors. Test your understanding of the complex ethical landscape in pediatric care.

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