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Related Experiment Videos

Is decision-making capacity an "essentially contested" concept in pediatrics?

Eva De Clercq1, Katharina Ruhe2, Michel Rost3

  • 1Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. eva.declercq@unibas.ch.

Medicine, Health Care, and Philosophy
|April 7, 2017
PubMed
Summary

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This study critiques current child decision-making capacity assessments, proposing a new framework. It argues for viewing capacity as context-dependent, not just a cognitive ability, to better involve children in healthcare decisions.

Area of Science:

  • Bioethics
  • Child Health Law
  • Psychology

Background:

  • International legislation supports involving children in healthcare decisions based on age and capacity.
  • Existing tools for assessing children's decision-making capacity often rely on cognitive criteria (e.g., Appelbaum and Grisso), which may not suit children's life situations.

Purpose of the Study:

  • To critically re-evaluate current definitions of decision-making capacity in children.
  • To propose an alternative conceptualization of capacity, moving beyond purely cognitive assessments.

Main Methods:

  • Conceptual analysis and critical reflection on existing frameworks for decision-making capacity.
  • Application of the philosophical concept of "essential contestability" to understand capacity.
Keywords:
CapacityChildrenDecision-makingEssentially contested conceptPediatrics

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Main Results:

  • Current capacity assessments may overemphasize cognitive abilities, neglecting contextual factors.
  • Capacity is not solely an inherent personal trait but is shaped by cultural and situational frameworks.
  • Viewing capacity as "essentially contested" highlights its dynamic and interpretive nature.

Conclusions:

  • Rethinking decision-making capacity as an essentially contested concept can advance ethical and practical approaches.
  • This perspective encourages a more nuanced understanding of children's involvement in healthcare decisions.
  • Adopting this framework may lead to more appropriate and equitable assessments of capacity.