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Children’s Competence for Health Care Decisionmaking

  • Dan W. Brock
Part of the Philosophy and Medicine book series (PHME, volume 33)

Abstract

What role should children play in decisionmaking about their health care?1 The doctrine of informed consent requires that medical treatment only be given to adults with their competent, informed and voluntary consent. The law, as well as common medical practice, presumes that adults are competent to decide about their medical treatment, though this presumption can be rebutted in particular instances. On the other hand, the law presumes that minors, who in most states are persons below the age of 18 years, are not competent to decide about their medical care; though with some exceptions to be noted below. For minors, the law generally holds that others, usually parents or guardians, are to decide for them about their medical treatment. The general presumption then in legal policy is that adults are entitled to decide about their medical care while children are not. However, medical practice, as we shall see, for good reason has often involved minors in decisionmaking about their care to a greater extent than the law seems to require.

Keywords

Decisional Authority Decisionmaking Capacity Health CARE DECISIONMAKING Parental Authority Life Plan 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Bibliography

  1. 1.
    Aiken, W. and La Follette, H. (eds.): 1980, Whose Child? Children’s Rights, Parental Authority, and State Power, Littlefield, Adams, Totowa, NJ.Google Scholar
  2. 2.
    Blustein, J.: 1982, Parents and Children: The Ethics of the Family, Oxford University Press, New York.Google Scholar
  3. 3.
    Brandt, R.: 1982, ‘Two Concepts of Utility’, in H. Miller, and W. Williams, (eds.), The Limits of Utilitarianism, University of Minnesota Press, Minneapolis, pp. 169–185.Google Scholar
  4. 4.
    Buchanan, A. and Brock, D. W.: 1986, ‘Deciding for Others’, Milbank Memorial Quarterly 64:Suppl. 2, 17–94.Google Scholar
  5. 5.
    Buchanan, A., with Gilfix, M. and Brock, D. W.: ‘Surrogate Decisionmaking for Elderly Individuals Who are Incompetent or of Questionable Competence’, National Technical Information Service, Washington, D.C. (forthcoming).Google Scholar
  6. 6.
    Capron, A.: 1982, ‘The Competence of Children as Self-Deciders in Biomedical Interventions’, in W. Gaylin, and R. Macklin, (eds.), Who Speaks For the Child, Plenum Press, New York, pp. 57–114.Google Scholar
  7. 7.
    Drane, I: 1985, ‘The Many Faces of Competency’, Hastings Center Report 15: 2, 17-21.CrossRefGoogle Scholar
  8. 8.
    Erikson, E.: 1963, Childhood and Society, 2nd Ed., W. W. Norton, New York.Google Scholar
  9. 9.
    Gaylin, W.: 1982, ‘Competence: No Longer All or None’, in W. Gaylin, and R. Macklin, (eds.), Who Speaks For the Child, Plenum Press, New York, pp. 27–54.Google Scholar
  10. 10.
    Grisso, T. and Vierling, L.: 1978, ‘Minors’ Consent to Treatment: A Developmental Perspective’, Professional Psychology 9, 412–427.CrossRefGoogle Scholar
  11. 11.
    Grodin, M. A. and Alpert, J. J.: 1983, ‘Informed Consent and Pediatric Care’, in G. B. Melton, G. P. Koocher, and M. J. Saks, (eds.), Children’s Competence to Consent, Plenum Press, New York, pp. 93–110.Google Scholar
  12. 12.
    Holder, A.: 1985, Legal Issues in Pediatric and Adolescent Medicine, 2nd Ed., Yale University Press, New Haven.Google Scholar
  13. 13.
    Houlgate, L.: 1980, The Child and the State, Johns Hopkins, Baltimore.Google Scholar
  14. 14.
    Keith-Spiegel, P.: 1976, ‘Children’s Rights as Participants in Research’, in G. P. Koocher, (ed.), Children’s Rights and the Mental Health Professions, Wiley, New York, pp. 53–81.Google Scholar
  15. 15.
    Leiken, S.: 1982, ‘Minor’s Assent or Dissent in Medical Treatment’, President’s Commission for the Study of Ethical Problems in Medicine, Making Health Care Decisions, Volume III: Appendices U.S. Government Printing Office, Washington, D.C., pp. 175–191.Google Scholar
  16. 16.
    Lewis, C. E.: 1983, ‘Decision Making Related to Health: When Could/Should Children Act Responsibly?’ in G. B. Melton, G. P. Koocher, and M. J. Saks, (eds.), Children’s Competence to Consent, Plenum Press New York, pp. 75–91.Google Scholar
  17. 17.
    Meisel, A.: 1979, ‘The Exceptions to the Informed Consent Doctrine: Striking a Balance Between Competing Values in Medical Decisionmaking’, Wisconsin Law Review, 413–488.Google Scholar
  18. 18.
    Melton, G. B.: 1983, ‘Decision Making by Children: Psychological Risks and Benefits’, in Melton, G. B., Koocher, G. P., and Saks, M. J. (eds.), Children’s Competence to Consent, Plenum Press, New York, pp. 21–40.Google Scholar
  19. 19.
    National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research: 1977, Research Involving Children, Appendix Volume, U.S. Government Printing Office, Washington, D.C.Google Scholar
  20. 20.
    Piaget, J.: 1965, The Moral Judgment of the Child, Free Press, New York.Google Scholar
  21. 21.
    Piaget, J.: 1972, The Chil’s Conception of the World, Littlefield, Adams, Totowa, NJ.Google Scholar
  22. 22.
    Piaget, J. and Inhelder, B.: 1969, The Psychology of the Child, Basic Books, New York.Google Scholar
  23. 23.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Bahavioral Research: 1982, Making Health Care Decisions, U.S. Government Printing Office, Washington, D.C.Google Scholar
  24. 24.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: 1982, ‘Patient Competence to Make Decisions About Medical Therapy’, unpublished.Google Scholar
  25. 25.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: 1983, Deciding to Forego Life-Sustaining Treatment, U.S. Government Printing Office, Washington, D.C.Google Scholar
  26. 26.
    Rawls, J.: 1971, A Theory of Justice, Harvard University Press, Cambridge, MA.Google Scholar
  27. 27.
    Schwartz, T.: 1982, ‘Human Welfare: What It Is Not’, in H. Miller, and W. Williams, (eds.): 1982, The Limits of Utilitarianism, University of Minnesota Press, Minneapolis, pp. 195–206.Google Scholar
  28. 28.
    Weithorn, L. A.: 1983, ‘Involving Children in Decisions Affecting Their Own Welfare: Guidelines for Professionals’, in G. B. Melton, G. P. Koocher, and M. J. Saks, (eds.), Children’s Competence to Consent, Plenum Press, New York, pp. 235–260.Google Scholar
  29. 29.
    Weithorn, L. A. and Campbell, S. B.: 1982, ‘The Competency of Children and Adolescents to Make Informed Treatment Decisions’, Child Development 53, 1589–1598.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • Dan W. Brock
    • 1
  1. 1.Brown UniversityProvidence

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