Paternalism: Parents and Children (MEDRADSC 3Y03)

What is paternalism in the context of healthcare?

Paternalism refers to the practice where someone makes decisions for another, such as parents or physicians making health care decisions for children.

What does Diekema's essay argue regarding parental decision-making?

Diekema argues that government agencies or physicians should only override parental decisions in exceptional cases, prioritizing family privacy and autonomy.

What standard does Diekema reject in his essay?

Diekema rejects the 'best interests' standard

- gov is justified to overrule parental decisions about child's medical tx when the parent's decision is not in the child's best interest

- however, 'best interest' is hard to determine

What principle does Diekema defend in his essay?

Diekema defends the 'harm principle'

- justifies government intervention when parental decisions are sufficiently harmful to the child

- decision significantly inc likelihood of serious harm compared to another option

Why does Diekema believe parents are generally reliable in decision-making for their children?

Diekema believes that parents tend to promote well-being and are the best judges of what is good for their children.

What are the challenges associated with the 'best interest' standard?

Determining 'best interest' is difficult as it involves value judgments, and can lead to government micromanagement of parenting.

What historical case does Diekema reference to support the harm principle?

Diekema references a 1944 Supreme Court case stating that the right to practice religion does not include exposing children to communicable diseases.

(A parent can hold a religious belief and make medical decsions based off that but a child cannot)

How does Diekema illustrate the complexity of applying the harm principle?

He uses the example of blood transfusions to show how different views can lead to varying conclusions about what constitutes harm

Physician POV:

- Nonmaleficence: treat pt to avoid harm

- Beneficence: death will occur w/o trasnfusion, benefit is that pt will live

- Justice: anyone that needs a trasnfusion can have it

Parent's POV

- Nonmaleficence: transfusion will lead to eternal suffering, which is worse than death

- Beneficence: what is the wellbeing of pt? Again, eternal suffering is worse than death

- Justice: unjust to interfere w/ child's afterlife

- Autonomy: parent's choice not to treat

TRUE or FALSE: The age of consent for medical treatment in Canada is 16.

FALSE: There is NO fixed age of consent for medical treatments in Canada. Some provinces may follow that the legal age of majority is the age of consent for medical tx. However, other provinces operate with the 'mature minor' ideology that states even if a child is NOT the age of majority, if the child is deemed to have the capacity to make a medical decision, they can.

What is the 'mature minor' idea for medical decision making?

Ideology that states even if a child is NOT the age of majority, if the child is deemed to have the capacity to make a medical decision, they can.

What is a potential consequence of government intervention in parental decisions?

It may lead to excessive government oversight in all aspects of parenting

What are the considerations Diekema suggests when evaluating interventions?

Considerations include:

- Does refusing tx risk serious harm?

- Is the intervention of proven efficacy?

- What are the benefits and burdens?

- Would any other option prevent serious harm and be less intrusive to parental autonomy?