Skip to main content
Log in

The Third Chair in the Examination Room: Practical Ethics of Decision-Making for the Pediatric Dermatologist

  • Pediatrics (R Sidbury, Section Editor)
  • Published:
Current Dermatology Reports Aims and scope Submit manuscript

Abstract

Decision-making in pediatric dermatology follows a model common to pediatric care. The parent or legal guardian provides informed permission for interventions with the child’s assent, where possible, acting in the best interests of the child. In most cases, this model works smoothly, but if the parent’s wishes and/or parenting style or the physician’s recommendations conflict with the wishes of the child, the minor patient may demand care that conflicts with the better judgment of the physician or parent, or the parent may not always act in what the physician believes to be the child’s best interests. Practical strategies for dealing with the ethical challenges of shared decision-making are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics, American Academy of Pediatrics. Pediatrics. Feb 1995;95(2):314-317.

  2. De Lourdes LM, Larcher V, Kurz R. Ethics Working Group of the Confederation of European Specialists in Pediatrics. Informed consent/assent in children. Statement of the Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP). Eur J Pediatr. 2003;162(9):629–33.

    Article  Google Scholar 

  3. Kopelman LM. The best interests standard for incompetent or incapacitated persons of all ages. J Law Med Ethics. 2007;35(1):187–96.

    Article  PubMed  Google Scholar 

  4. English A. State minor consent laws: a summary. Chapel Hill, NC: Center for Adolescent Health and the Law; 2010.

    Google Scholar 

  5. Bloom K, Bercovitch L. Who speaks for the child? Consent, assent and confidentiality in pediatric dermatology. In: Bercovitch L, Perlis C, editors. Dermatoethics. London: Springer; 2012. Discussion of ethical and legal principles of parent-child-physician triad.

    Google Scholar 

  6. Alderson P. Competent children? Minors' consent to health care treatment and research. Soc Sci Med. 2007;65(11):2272–83.

    Article  PubMed  Google Scholar 

  7. Coleman DL, Rosoff PM. The legal authority of mature minors to consent to general medical treatment. Pediatrics. 2013;131(4):786–93. Discussion and table of state-specific exemptions to minors making medical decisions.

    Article  PubMed  Google Scholar 

  8. Beauchamp T, Childress JF. Principles of biomedical ethics, vol. 99. New York: Oxford University; 2009.

    Google Scholar 

  9. Cummings C, Mercurio MR. Ethics for the pediatrician: autonomy, beneficence and rights. Pediatr Rev. 2010;31(6):252–5.

    Article  PubMed  Google Scholar 

  10. Jeffery K. Supportive holding or restraint: terminology and practice. Paediatr Nurs. 2010;22(6):24–8.

    Article  PubMed  Google Scholar 

  11. Grodin M, Alpert KK. Informed consent and pediatric care. New York: Plenum; 1983.

    Google Scholar 

  12. Weithorn LA, Schere DG. Children's involvement in research participation decisions: psychological consideration. In: Grodin MG, Glantz LH, editors. Children as research subjects: science, ethics and law. New York: Oxford University Press; 1994.

    Google Scholar 

  13. La Greca A, Prinstein MJ. Peer group. Needham Heights: Allyn & Bacon; 1999.

    Google Scholar 

  14. Lipstein EA, Brinkman WB, Britto MT. What is known about parents' treatment decisions? A narrative review of pediatric decision making. Med Decis Making. 2012;32(2):246–58. Summary of several prior studies on factors influencing parental decision making.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Chan R, Shum D, Toulopoulou T, Chen EYH. Assessment of executive functions: review of instruments and identification of critical issues. Arch Clin Neuropsychol. 2008;23:201–16.

    Article  PubMed  Google Scholar 

  16. Casey J, Jones RM, Hare TA. The adolescent brain. Ann N Y Acad Sci. 2008;1124:111–26.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Cherry M. Parental authority and pediatric bioethical decision making. J Med Philos. 2010;35:553–72. Adolescents may be able to perceive and assess risk but may be more apt to make a risky decision due to poor judgement of how risks apply to oneself.

    Article  PubMed  Google Scholar 

  18. Baumrind D. Rearing competent children. San Francisco: Jossey-Bass; 1989.

    Google Scholar 

  19. Steinberg L, Elmen DJ, Mounts NS. Authoritative parenting, psychosocial maturity and academic success among adolescents. Child Dev. 1989;60:1424–36.

    Article  CAS  PubMed  Google Scholar 

  20. Steinberg L, Mounts NS, Lamborn SD, Dornbusch SM. Authoritative parenting and adolescent adjustment across varied ecological niches. J Adolesc Res. 1991;1:19–36.

    Google Scholar 

  21. Dornbusch S, Ritter P, Liederman P, Roberts D, Fraleigh M. The relation of parenting style to adolescent school performance. Child Dev. 1987;58:1244–57.

    Article  CAS  PubMed  Google Scholar 

  22. Steinberg L, Lamborn SD, Dornbusch SM. Impact of parenting practices on adolescent achievement: authoritative parenting, school involvement, and encouragement to succeed. Child Dev. 1992;63:1266–81.

    Article  CAS  PubMed  Google Scholar 

  23. Partridge B. Adolescent psychological development, parenting styles, and pediatric decision making. J Med Philos. 2010;35:518–25.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

AR Wang and L Bercovitch both declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lionel Bercovitch.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, A.R., Bercovitch, L. The Third Chair in the Examination Room: Practical Ethics of Decision-Making for the Pediatric Dermatologist. Curr Derm Rep 3, 182–186 (2014). https://doi.org/10.1007/s13671-014-0090-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13671-014-0090-1

Keywords

Navigation