Pediatric Decision Making: Ross, Rawls, and Getting Children and Families Right

Area of Science:

• Pediatric Bioethics
• Medical Decision-Making Models
• Child Psychology

Background:

• Current pediatric decision-making often centers on the 'best interest of the child' standard.
• Established models, like Buchanan and Brock's, position parents as primary surrogate decision-makers.
• Recent work by Ross explores 'constrained parental autonomy' within these frameworks.

Purpose of the Study:

• To critically evaluate existing pediatric decision-making models, particularly those based on Buchanan and Brock's work.
• To advocate for a more inclusive approach that considers the child's developing autonomy and capabilities.
• To explore how justice considerations for the child and family can enrich clinical encounters.

Main Methods:

• Conceptual analysis and critique of existing ethical models in pediatric decision-making.
• Engagement with literature on 'constrained parental autonomy' and principles of justice (Rawls, Ross).
• Focus on the child's developmental trajectory, emotional growth, and emerging autonomy.

Main Results:

• Models that exclude or limit direct engagement with the child patient are insufficient.
• Underappreciation of parental autonomy and the parent-child dynamic limits the scope of decision-making.
• Integrating considerations of justice and the child's primary goods enhances the decision-making process.

Conclusions:

• Pediatric decision-making requires a more dynamic model that includes the child's perspective and evolving autonomy.
• Parental autonomy and the parent-child relationship are crucial elements that should be fully integrated.
• A comprehensive approach considers justice for the child and family, informed by developmental psychology.