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The Default Position: Optimizing Pediatric Participation in Medical Decision Making.
Aleksandra E Olszewski1, Sara F Goldkind2
1a Seattle Children's Hospital.
The American Journal of Bioethics : AJOB
|February 22, 2018
Summary
Children should be included in medical decisions by default. This study proposes a systematic approach to guide clinicians on when and how to involve children in their healthcare choices, addressing a gap in current literature.
Area of Science:
- Pediatric Healthcare
- Medical Ethics
- Clinical Decision-Making
Background:
- Children's involvement in medical decision-making is ethically recommended but practically challenging for clinicians.
- A structured method for assessing and implementing child participation in healthcare decisions is lacking in existing literature.
Purpose of the Study:
- To propose a systematic, stepwise approach for determining when and how to include children in medical decision-making.
- To provide a framework for clinicians to optimize child involvement in their healthcare.
- To address the gap in the literature regarding a practical guide for child assent in medical contexts.
Main Methods:
- Literature review on child participation in healthcare and related ethical/legal frameworks.
- Development of a systematic approach based on the literature review.
- Application of the proposed approach to analyze challenging clinical case studies involving adolescents.
Main Results:
- A systematic approach for assessing child capacity and willingness to participate in medical decisions has been developed.
- The approach integrates considerations from research assent, clinical care, and decision-making for adults with cognitive impairments.
- Case studies illustrate the practical application of the proposed framework in complex scenarios.
Conclusions:
- The proposed systematic approach offers a practical guide for clinicians to enhance children's involvement in medical decision-making.
- Implementing this approach can help ensure children's voices are routinely heard in their healthcare, respecting their developing autonomy.
- Further application and refinement of this framework can improve ethical and effective child-centered care.
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