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Journal of Bioethical Inquiry

, Volume 12, Issue 3, pp 429–436 | Cite as

Conflicts Between Parents and Health Professionals About a Child’s Medical Treatment: Using Clinical Ethics Records to Find Gaps in the Bioethics Literature

  • Rosalind McDougallEmail author
  • Lauren Notini
  • Jessica Phillips
Original Research

Abstract

Clinical ethics records offer bioethics researchers a rich source of cases that clinicians have identified as ethically complex. In this paper, we suggest that clinical ethics records can be used to point to types of cases that lack attention in the current bioethics literature, identifying new areas in need of more detailed bioethical work. We conducted an analysis of the clinical ethics records of one paediatric hospital in Australia, focusing specifically on conflicts between parents and health professionals about a child’s medical treatment. We identified, analysed, and compared cases of this type from the clinical ethics records with cases of this type discussed in bioethics journals. While the cases from journals tended to describe situations involving imminent risk to the child’s life, a significant proportion of the clinical ethics records cases involved different stakes for the child involved. These included distress, poorer functional outcome, poorer psychosocial outcome, or increased risk of surgical complications. Our analysis suggests that one type of case that warrants more detailed ethics research is parental refusal of recommended treatment, where the refusal does not endanger the child’s life but rather some other aspect of the child’s well-being.

Keywords

Paediatrics Clinical ethics Parents Conflict 

Notes

Acknowledgements

The authors thank Alison Brookes for her research assistance. This project was funded by an Australian Research Council Discovery Early Career Researcher Award (grant number DE120100488).

References

  1. Appel, J.M. 2009. Neonatal euthanasia: Why require parental consent? Journal of Bioethical Inquiry 6(4): 477–482.CrossRefGoogle Scholar
  2. Austin, W., J. Kelecevic, E. Goble, and J. Mekechuk. 2009. An overview of moral distress and the paediatric intensive care team. Nursing Ethics 16(1): 57–68.CrossRefPubMedGoogle Scholar
  3. Boyle, R.J., R. Salter, and M.W. Arnander. 2004. Ethics of refusing parental requests to withhold or withdraw treatment from their premature baby. Journal of Medical Ethics 30(4): 402–405.PubMedCentralCrossRefPubMedGoogle Scholar
  4. Brazier, M. 2004. Letting Charlotte die. Journal of Medical Ethics 30(6): 519–520.PubMedCentralCrossRefPubMedGoogle Scholar
  5. Carnevale, F.A. 2005. Ethical care of the critically ill child: A conception of a “thick” bioethics. Nursing Ethics 12(3): 239–252.CrossRefPubMedGoogle Scholar
  6. Cowley, C. 2003. The conjoined twins and the limits of rationality in applied ethics. Bioethics 17(1): 69–88.CrossRefPubMedGoogle Scholar
  7. DeMarco, J.P., D.P. Powell, and D.O. Stewart. 2011. Best interest of the child: Surrogate decision making and the economics of externalities. Journal of Bioethical Inquiry 8(3): 289–298.CrossRefGoogle Scholar
  8. Diekema, D.S. 2004. Parental refusals of medical treatment: The harm principle as threshold for state intervention. Theoretical Medicine and Bioethics 25(4): 243–264.CrossRefPubMedGoogle Scholar
  9. Freysteinson, W. 2009. The twins: A case study in ethical deliberation. Nursing Ethics 16(1): 127–130.CrossRefPubMedGoogle Scholar
  10. Glover, J. 2006. Should the child live? Doctors, families and conflict. Clinical Ethics 1(1): 52–59.CrossRefGoogle Scholar
  11. Gold, H., G. Hall, and L. Gillam. 2011. Role and function of a paediatric clinical ethics service: Experiences at the Royal Children’s Hospital, Melbourne. Journal of Paediatrics and Child Health 47(9): 632–636.CrossRefPubMedGoogle Scholar
  12. Goldworth, A. 2010. The persistence of physician–parent conflicts. Cambridge Quarterly of Healthcare Ethics 19(4): 563–566.CrossRefPubMedGoogle Scholar
  13. Guillemin, M., and L. Gillam. 2006. Telling moments: Everyday ethics in health care. Melbourne: IP Communications.Google Scholar
  14. Harris, J. 2003. Consent and end of life decisions. Journal of Medical Ethics 29(1): 10–15.PubMedCentralCrossRefPubMedGoogle Scholar
  15. Hui, E. 2008. Parental refusal of life-saving treatments for adolescents: Chinese familism in medical decision-making re-visited. Bioethics 22(5): 286–295.CrossRefPubMedGoogle Scholar
  16. Jecker, N.S. 2011. Medical futility and the death of a child. Journal of Bioethical Inquiry 8(2): 133–139.CrossRefGoogle Scholar
  17. Jonas, M. 2007. The Baby MB case: Medical decision making in the context of uncertain infant suffering. Journal of Medical Ethics 33(9): 541–544.PubMedCentralCrossRefPubMedGoogle Scholar
  18. Kaveny, M.C. 2002. Conjoined twins and Catholic moral analysis: Extraordinary means and casuistical consistency. Kennedy Institute of Ethics Journal 12(2): 115–140.CrossRefPubMedGoogle Scholar
  19. Kipnis, K. 2007. Harm and uncertainty in newborn intensive care. Theoretical Medicine and Bioethics 28(5): 393–412.CrossRefPubMedGoogle Scholar
  20. Komesaroff, P.A. 1995. From bioethics to microethics: Ethical debate and clinical medicine. In Troubled bodies: Critical perspectives on postmodernism, medical ethics, and the body, edited by P.A. Komesaroff, 62–86. Melbourne: Melbourne University Press.Google Scholar
  21. Kopelman, L.M., and A.E. Kopelman. 2007. Using a new analysis of the best interests standard to address cultural disputes: Whose data, which values? Theoretical Medicine and Bioethics 28(5): 373–391.CrossRefPubMedGoogle Scholar
  22. McDougall, R., and L. Notini. Unpublished. What kinds of cases do paediatricians refer to clinical ethics? Insights from 184 case referrals at an Australian paediatric hospital.Google Scholar
  23. McDougall, R.J., and L. Notini. 2014. Overriding parents’ medical decisions for their children: A systematic review of normative literature. Journal of Medical Ethics 40(7): 448–452.Google Scholar
  24. McDougall, R., C. Delany, M. Spriggs, and L. Gillam. 2014. Collaboration in clinical ethics consultation: a method for achieving “balanced accountability.” The American Journal of Bioethics 14(6): 47–48.Google Scholar
  25. McPhee, J., and C. Stewart. 2005a. Recent developments in law. Journal of Bioethical Inquiry 2(1): 4–9.CrossRefPubMedGoogle Scholar
  26. McPhee, J., and C. Stewart. 2005b. Recent developments in law. Journal of Bioethical Inquiry 2(2): 63–68.CrossRefPubMedGoogle Scholar
  27. McPhee, J., and C. Stewart. 2005c. Recent developments in law. Journal of Bioethical Inquiry 2(3): 122–129.CrossRefPubMedGoogle Scholar
  28. Nobbs, C. 2007. Probability potentiality. Cambridge Quarterly of Healthcare Ethics 16(2): 240–247.CrossRefPubMedGoogle Scholar
  29. Opel, D.J., and B.S. Wilfond. 2009. Cosmetic surgery in children with cognitive disabilities: Who benefits? Who decides? The Hastings Center Report 39(1): 19–21.CrossRefPubMedGoogle Scholar
  30. Rhodes, R., and I.R. Holzman. 2004. The not unreasonable standard for assessment of surrogates and surrogate decisions. Theoretical Medicine and Bioethics 25(4): 367–385.CrossRefPubMedGoogle Scholar
  31. Richards, B., and C. Stewart. 2013. Professional conduct and making decisions for minors. Journal of Bioethical Inquiry 10(1): 11–15.CrossRefPubMedGoogle Scholar
  32. Rossiter, K., and S. Diehl. 1997. Gender reassignment in children: Ethical conflicts in surrogate decision making. Pediatric Nursing 24(1): 59–62.Google Scholar
  33. Savell, K. 2011. Confronting death in legal disputes about treatment-limitation in children. Journal of Bioethical Inquiry 8(4): 363–377.CrossRefGoogle Scholar
  34. Skene, L. 2004. Disputes about the withdrawal of treatment: The role of the courts. The Journal of Law, Medicine & Ethics 32(4): 701–707.CrossRefGoogle Scholar
  35. Stewart, C. 2007. Recent developments in law. Journal of Bioethical Inquiry 4(1): 3–5.CrossRefGoogle Scholar
  36. Unsworth-Webb, J. 2006. Potential termination of pregnancy in a non-consenting minor. Nursing Ethics 13(4): 428–437.CrossRefPubMedGoogle Scholar
  37. Worthley, J.A. 1997. The ethics of the ordinary in healthcare: Concepts and cases. Chicago: Health Administration Press.Google Scholar
  38. Yen, B.M., and L.J. Schneiderman. 1999. Impact of pediatric ethics consultations on patients, families, social workers, and physicians. Journal of Perinatology 19(5): 373–378.CrossRefPubMedGoogle Scholar

Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2015

Authors and Affiliations

  • Rosalind McDougall
    • 1
    • 2
    Email author
  • Lauren Notini
    • 1
    • 2
  • Jessica Phillips
    • 1
    • 2
  1. 1.Centre for Health Equity, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleAustralia
  2. 2.Children’s Bioethics CentreRoyal Children’s Hospital, MelbourneParkvilleAustralia

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