ForumTouchy Subjects ► Do you think guardians should have absolute say in child Healthcare?
So this question came to me quite a while ago after watching a episode of Grey's Anatomy. The first one that I think of is an episode where a 16 year old had a face deformation but she was Jehovah Witness so she couldn't get a blood transfusion so no surgery. In the Episode she sneaks out and tried to get the surgery without parent consent. She didn't care about the blood transfusion, she wanted the surgery no matter what it meant. She was later caught and in order to try and get the surgery she took a scapulae and tor a huge gash in her face to try and get them to fix it. She was taken into surgery and died from blood lost because the guardian would not consent to a blood confusion.

My point if this is, should parents have absolute say in a child's healthcare even if it is directly against the child's wishes and health? Because I personally don't think so.
  
It's a tricky question. We have to draw a line somewhere, because obviously five-year-olds cannot make informed decisions on their own health. I frankly don't think everyone who is 16 is able to make decisions like that, either.
It's not always clear-cut like 'cure my facial deformity at little risk'. Some procedures might increase quality of life, but at significant risk to that life. I don't think the average sixteen-year-old is emotionally or mentally equipped to deal with those kinds of decisions.
The line is drawn (at least in the US) at 18. Where would you draw the line of when a person should be able to make their own medical decisions? Because there has to be one. Two-year-olds can't comprehend complex medical topics.
  
I think it depends on the procedure, for example if it is to save the person, like blood transfusion in surgery, and the kid wants it, a good line to for me draw would be about 16, teens nowadays can be more mature than you think.

A good line is also 16 for any life or death decisions, such as needed surgery that the parent wont agree too, otherwise its 18
  
I think that at least for standard, medically necessary procedures (such as blood transfusions), a child at any age should be able to elect to get treatment even against his or her parents' wishes.
  
Does it even matter what the child thinks, at that point? Is there much of an ethical difference between a child who says "yes please save my life with a blood tranfusion" and "no please let me die?" Or a child who is too young to even understand the question?
  
Having no medical expertise, I would assume any legislation regarding resolution of this issue might require changing the legal "age of consent". In this particular case (though fictional) I think changing the legal age of consent to 16 (or possibly another age) for medical issues regarding one's own body wouldn't be out of the question. This could be a slippery slope to other issues; but that's the most realistic change I'd see that would attempt to resolve such issues. Keep in mind that the "age of consent" is already 16 in much of the world, and even only lowering this to medical issues involving one's own healthcare would be a huge legal burden to pass.
  
Or conversely, make "refusing life saving treatment" the thing that requires consent. As in, if you're 18 and decide you don't want a transfusion on religious grounds go ham, but till 18 you are not old enough to make that decision.
  
Grayseff said:
Or conversely, make "refusing life saving treatment" the thing that requires consent. As in, if you're 18 and decide you don't want a transfusion on religious grounds go ham, but till 18 you are not old enough to make that decision.


But what if you want the treatment to save your life, but for whatever reason your guardian says no. They have effectively killed you at that point. I understand not giving children the decision until 18 for normal procedures that are not life or death, but it is life or death the person should have more of a say. or what if they want to refuse treatment for some reason like they dont want to go though kemo? a good valid reason? They can still be forced to do treatment. I also dont think you are giving teens enough credit. They are more mature than they let onto. I think 100% that they are capable of making those decisions.
  
I think "saving a child's life" in many cases supercedes parents' wishes. Power of attorney is already tenuous and it's often easy for family members to have it legally revoked if they don't believe the person with PoA is acting in good faith.

Edit: another example might be ritual scarification: I can easily imagine that a consenting adult would be allowed to perform some religious rite relying on pain or mutilation, but it would and should absolutely be considered child abuse to force someone under the age of consent to perform it.
  
^Good point and example.

I was focusing more on legal action/precedence than floating the original idea, which you're cutting towards as well. How do you (anybody) think that this issue could be legally (through legislation/culture/however) resolved? Is the focus of this issue a minor (with a legal guardian) being unable to make impacting decisions regarding their own health? I believe the cause of this issue is the current legal status of those under the age of consent and the idea (or legal precedence) of parents holding the aforementioned power of attorney. That's two issues intertwined in this situation.
  
Fwip said:
Does it even matter what the child thinks, at that point?
Probably not, but I thought I'd start with a weaker assertion and see how people responded. 😃

What do you guys think about this framework, for some values of A, B, and C?
  • Age 0-A: The state/medical professionals can compel uncontroversial, medically necessary (saving life and limb) procedures against legal guardians' will. Other procedures require only guardian permission.
  • Age A-B: Necessary procedures require either guardians' or patient's consent. Elective procedures require both.
  • Age B-C: Necessary procedures require only patient's consent. Elective procedures require both.
  • Age C+: All procedures require patient's consent.
The idea is designed to:
  • Prevent guardians from denying necessary treatment to the very young or to children old enough to choose it
  • Allow parents to protect young children from bad choices (not getting beneficial treatment or electing to harmful/dubious treatment)
  • Restrict parents' ability to deprive older children of autonomy
  • Give people progressively more autonomy as they age
  
I think that this idea would be a great frame work and also addresses all the problems. If only it could be implemented into law
  
It's reasonably obvious I hope that 18 is age C, since that's where you're legally responsible for yourself only. It almost lines up with school ages I feel, 0-6, 6-13, 13-18. That said I have no idea how practical those rules are.

It just seems bizarre that we can remove children from their parents for abusive behaviour that will affect their quality of life, but not remove them when the child's actual life is at stake
  
I think it depends on the exact procedure being discussed.

For example, I don't think it would be bad for a parent to be able to force their 15 year old to have braces. The only downside is that you look kinda dorky for a year or so. However, I DO think it would be bad for a parent to be able to force a 15 year old to carry a child to term or have an abortion (note: not trying to turn this into an abortion debate, so please don't). The long term impact, either positive or negative, on the person's life and their body must be considered. Breast reduction for back pain might also be another medical decision that's not so cut and dry. Even male circumcision could fall into this area.

Elective quality of life/health procedures are very murky.
  
Very small point, but I'd like to mention that the show was actually Night Shift, not Grey's Anatomy.
  
Very small point, but I'd like to mention that the show was actually Night Shift, not Grey's Anatomy.


my bad, I watch both
  
What about denying highly invasive and potentially dangerous surgeries? I had to get ... I’d have to look at my X-rays again, but it was something like 11 (EDIT: more than 11, my entire thoracic spine is fused) vertebrae fused? A lot. It was intense, I needed blood transfusions and hald a halfway collapsed lung after it was over. Anyway, I didn’t want that surgery. Would you, or anyone, as a fifteen year old, want to get sliced open, have your discs popped, have a doctor implant metal rods down your spine, then take screws and screw the metal rods into your vertebrae? I sure as fuck didn’t. If I hadn’t gotten the surgery though, my lung capacity would be markedly lower than it is today. The way the curve was going, there would have eventually been pressure against my heart, and I would have developed bad kyphosis (hunch back). Doing a spinal fusion surgery for a spine that messed up after you’re fully grown is usually more dangerous than at a time before because the worse it progresss, the harder the surgery becomes for the surgeon. Of course I had it anyway. I think it’s pretty easy to look at that above situation and say “Shut the fuck up. Put this mask on your face. We’re cutting you open, kid”.

Ask a teenager to summarize “health” when they’re acting completely naturally and not sitting down on the spot trying to come up with something they know is more correct than what they want to be correct. You’re gonna hear a bunch of bullshit and a bunch of “whatever, but” and “but it’s my body” (if someone comes around and thinks I don’t know when this is a valid argument...) and “but, but, but, but” or worse “I can handle any health problems that come my way”
  
There will always be gray areas since the terms "necessary" and "elective" are fuzzy. In your case it was ongoing quality of life vs. initial pain and risk - not very cut-and-dry. For the sake of public policy (and/or professional policy), we could probably come up with a reasonable set of guidelines/categories, but individual situations will call for discretion.
  
Whose discretion should it be up to? I'm honestly not sure who the "final" authority should be on this.
  
Ultimately the courts, I suppose.
  
Also medical professionals on whether a treatment is necessary.

There are a lot of options before reaching the courts. For example, there may be alternative treatments which would not normally be considered but cover the medical necessities without compromising the parents' beliefs.
  
I question whether court hearings would be a good use of a physician's time. They are lengthy and involved, and medical resources are often stretched thin - for a hospital to be paying for a physician to go to a court to determine whether a procedure should be done does not seem like a good use of resources.
  
But that would only be necessary given the parent and child couldn't agree. How often would that be? (Actually asking)
  
Wanted to bring up another media source since it seemed relevant, if anyone's seen/read My Sister's Keeper, medical emancipation is an already established legal possibility, although how/when it can be obtained varies from state to state.
  
Zia said:
I question whether court hearings would be a good use of a physician's time.
There are cases where I think it's appropriate for "expert witnesses" to testify, but I would prefer medical professionals be involved primarily in the writing of laws/standards (which judges then interpret).
  
Forum > Touchy Subjects > Do you think guardians should have absolute say in child Healthcare?