Journal of Clinical Research & Bioethics

Parental Autonomy Versus Child Welfare an Ethical Analysis

Naila Khalid^* Department of Nursing, University of Lahore, Lahore, Pakistan
^*Correspondence: Naila Khalid, Department of Nursing, University of Lahore, Lahore, Pakistan, Email:

Received: 21-May-2021 Published: 11-Jun-2021, DOI: 10.35248/2155-9627.21.s11.001

Introduction

Autonomy is an ethical principle which is derived from the Greek word autos (self) and nomos (rule), which means a right to take decision. This right is mostly used in health care system; based on the given situation (Rule). The second principle which is striking in this paper is beneficence. It promotes the ethical responsibility to do for the benefit of patients [1].

In a similar way, parents are responsible to make best decision for their child’s health. They are legally authorized and have a right to receive information from the health care provider, so that they can come up with a decision [2].

Literature Review

Case scenario

A 6-year child presented in oncology ward with his parents, on medical history it was revealed that he was suffering from fever since one month with bleeding from gums and a pale skin. The laboratory reports revealed: Hemoglobin (HB): 7.9 and Platelet (Plt): 13,000. A decision to transfuse platelets and pack cells was made and then bone marrow biopsy was planned. When the report of bone marrow biopsy was collected it confirmed the diagnosis acute lymphocytic leukemia. After discussion with consultant, family refused for the treatment and left against medical advice. After few days, the patient landed again in ER with severe distress and bleeding from gums, nose and G.I.T tract with very low platelets count. The patient expired after one hour of admission. So, parents followed their autonomy and lost the child. And the dilemma is finding between the autonomy and beneficence of the patient.

From the lens of health care provider

Health care providers play an important role for the beneficence of patients. They take best decisions of treatment for the betterment of patient’s life. The beneficence states that the health care team must perform all those duties through which they can provide benefit to the patient in any condition. Furthermore, all implementations and managements suggested must be within the purpose to organize best plans for the patient. To provide beneficence, health care professionals must hold a high level of skills and awareness.

According to ethical point of view, morality needs to contribute to the welfare of patients and prevent from harm but not only respect the patient’s autonomy. The ethical principle of beneficence possibly needs more consideration for those who are on threat; because health care providers need to take best implementations to relief people and not just abstain from harm. Patient’s beneficence represents treatment's goal, explanation and reasoning [3].

Health care providers (HCP) are obligated to do so best for their patients as mentioned in their oath they take after their training.

“I will implement services, for the welfare of the suffered people, all procedures that are needed, avoiding those identical tricks of treatment and therapeutic nihilism” [4].

HCP not only bound to follow the ethical rules of reputable organization but values, morals beliefs and respect on the patients are also taken in accounts. All the medical treatment needs sincerity to maintain the standards of ethical practices in mind [5].

In a similar way, they are responsible to explain each and everything to the patient or attendant of the patient about the diagnosis, treatment, and prognosis. They are accountable for the correct and detailed information regarding disease so that the attendants can take best decision about the treatment of their patient, because without consent, physicians can’t proceed treatment. HCP should be best counselor for the patients and their family. But this requirement is neglected most of the time, such as in this case health care provider explained them about the disease and chemotherapy treatment about the prognosis and successfulness of treatment.it might have the possibility that family’s concept about chemotherapy were not fully cleared. Therefore, it is important to know the level of understanding of family so that they can make best decision for their children.

In relation of this case refusal for treatment, HCP should attempt to agree the parents for treatment and understand that condition of the child and the effects of treatment and try to help them to identify the factors behind their refusal. HCP must ensure to convey the correct information in a simple language which family could understand easily. It would be best action to ensure that the parents are fully acknowledged about the disease and treatment, and well informed about benefits of treatment and harms of refusal [6].

From the lens of parents

According to the case report it is known that the patient is a child and children have no capacity to take decision for themselves. There is an age limit by which they are allowed for it. According to Christy and Mark, 2007, all children are entitled to effective medical treatment that is likely to prevent serious harm, or suffering, or death.

On contrary, autonomy of parents is different from the autonomy of patients to make decisions for themselves. While adult patients are generally thought to have an absolute right to refuse medical treatment for themselves, we don’t usually think that parents can refuse all medical treatment for their children [7].

As we know that the age of patient in this scenario is under 12 years that is why he is ethically unable or having no ability to make best decision for his treatment due to this reason his parents took the authority to make decision in place of their children. The conflict is that the parents interfere with the advice of health care provider and the betterment of the patient by refusing of treatment which resulted in severe harm. Although, it is supposed under law that there are situations where HCP can challenge this primacy, in order to have option to the best actions for the benefit of their patients [8].

My justification

According to my point of view there is some lacking, on HCP’s end. He could explain each and every thing regarding patient’s condition its treatment as well as prognosis. I think as the parent refused to take the treatment regarding cancer HCP should asked the reasons of refusal. He could inquire whether they understand what is being told or not. Health care provider must inquire what they understand about the patients’ disease; that is the reason HCP should do more efforts for the best decision to make by parents on the behalf of their children. As the HCP was doing his job for the beneficence of children should also save the life of patient by subsiding the confusion state of parents. It might be possible that HCP was overburdened because he was performing long call duty of 36 hours and parents were also not agree to listen again about child’s disease and treatment.

Similarly parents are very sensitive for their children and want to prevent from any harm and save his life as far as health are concerned. But most of the time as decision maker about health of the child they make wrong decisions going after their emotional values and at the end they regret for their entire life. According to the Fiqh’s point of view, parents or authorized caretakers are obligated to have only the child’s best welfares in mind and not reject trials by which the child’s life depends within practical restrictions [2].

On the other hand, if parents made right decision for their child and follow the decision of HCP then it would be possible that the child could have been able to survive. It was the right of a child that he must be given a chance of survival with better medical care. But the parents did not take the right decision and HCP did not take effort to counsel them again. A big gap of communication was there due to which the dilemma raised hence, Moreover according to the 1173 of the Civil Code of the Islamic Republic of Iran, “If the physical well-being or ethical learning of a child is threatened as a consequence of negligence or ethical degradation of the parents who have supervision of the kid, the law court can take any judgment it believes suitable about protection of the or custody child upon appeal of his or her relatives, protector or the Public Prosecutor. “Such laws show that custody is liable upon protection of the child’s wellbeing or, in other words, best benefits. It is notable that in the Shi’a Fiqh the justice can terminate a parent’s responsibility of his child if his inability or dishonesty is recognized.

Discussion and Recommendations

In the above scenario as the HCP felt that that the decision of parents was clearly wrong? Here HCP should involve the institutional ethical committee for further support and guideline. If due to any reason the ethical committee was not available, then he could have involved the local child protection management authority and legal system, so that any situation which involves such dilemma could be prevented the child from harm.

Conclusion

Consequently, the refusal of treatment is very common in hospital or clinical practices. This situation is challenging when the parents do not agree to listen the advice of HCP regarding the patients who is a child. It is a very sensitive issue that leaves the HCP to think either to left the patient for dying or insist the family for treatment. The hospital ethical committee should involve in such issue to avoid these kinds of losses which no one can replace during entire life.

REFERENCES

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