Pediatric Ethics Issues and Clinical Ethics Consultation in the United States

Abstract

Medical care for children poses a challenge that is rarely experienced in adult medical care. The pediatric patient is under the authority of someone else, and they are rarely authorized to make the decisions that determine whether or not those procedures and interventions will take place. Further, most children follow a developmental process that leads them to the maturity of adulthood, and their development begins to raise the issue of where and when, along this process, a person should have the authority to take over decision making. These facts create a unique moral space for pediatric medicine.

All medical care aims at benefiting patients. What constitutes “benefit” for any particular patient, however, can be a struggle to determine. At the same time, “Who decides on benefit?” has equal moral weight. In the United States, we have come to see that in adult care autonomous adults are able to decide what is of benefit to themselves. The landscape is different in pediatrics. In fact, in pediatrics there is a presumption for parental authority over the decisions of their children. Pediatric decision making and parental authority, then, is governed by important moral precepts—the Best (or, at least, Reasonable) Interests Standard and the Harm Principle. As children mature, determining how robustly they should participate and even when or if they should have the authority to make their own healthcare decisions must be addressed, and precepts like the “mature minor doctrine” should be considered.