Pediatricians' most difficult decision

Journal of Clinical Ethics

Volumn 11, Issue 2, 2000, Pages 99-111

  Howe, Edmund G ^a  

^a UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHILD PARENT RELATION; DECISION MAKING; HUMAN; HUMAN RELATION; INFORMED CONSENT; PARENT; PEDIATRICS; PROFESSIONAL PATIENT RELATIONSHIP; TREATMENT OUTCOME;

PROFESSIONAL PATIENT RELATIONSHIP;

DECISION MAKING; HUMANS; MEDICAL FUTILITY; PARENT-CHILD RELATIONS; PARENTS; PEDIATRICS; PROFESSIONAL-FAMILY RELATIONS; THIRD-PARTY CONSENT;

EID: 0034208747     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (13)

1. Throughout this article, "pediatricians" refers to pediatricians and others who are involved in the care of children.
2. This decision may be particularly difficult for pediatricians. As a profession, they have greater emotional sensitivity to others' feelings, because this is what working with children requires. Half of the practicing pediatricians in Massachusetts, for example, would consider violating child abuse laws if reporting could result in a family's deportation. P.L. Geltman and A.F. Myers, "Immigration Reporting Laws: Ethical Dilemmas in Pediatric Practice," American Journal of Public Health 88, no. 6 (June 1998): 967-8.
3. Another study supporting that pediatricians are different is N. Lynoe and B. Mattsson, "Loyalty Conflicts in Medical Practice/A Comparative Study of General Practitioners,' Paediatricians' and Gynecologists' Assessments of Three Cases," Scandinavian Journal of Primary Health Care 16 (1998): 135-40.
4. A threshold resource on parent-child interaction is S. Greenspan and N.B. Lewis, Building Healthy Minds (Cambridge, Mass.: Perseus Books, 1999);
5. on facilitating patient learning, The Medical Interview, ed. M. Lipkin, S.M. Putnam, and A. Lazare (New York: Springer, 1995);
6. and on facilitating parents' learning, S. McDonough, "Promoting Positive Early Parent-Infant Relationships Through Interaction Guidance," Child and Adolescent Psychiatric Clinics of North America 4 (1995): 661-72.
7. E.G. Howe, "Treating Infants Who May Die," The Journal of Clinical Ethics 9, no. 3 (Fall 1998): 215-24.
8. Aside from other reasons, consulting with ethics committees about whether to oppose parents is essential if pediatricians are to avoid unbearable stress.
9. As another example, parents may be so committed to their children that they cannot accept disappointing information. I recall, for instance, a child who could not speak clearly. Testing indicated that this symptom resulted from brain impairment. His father could not accept this. He believed his child's tongue was abnormally fixed to the floor of his mouth and insisted that his son have surgery. The physician refused. The father's outrage may have been destructive, leading him to avoid following up on the speech therapy recommended for his son. Parents' commitment is particularly likely to cause moral blindness when other children's competing needs are at stake. In one instance, in which the patient involved was not my own, I expressed to a parent in a nonclinical context my personal hope that if there were only one ICU bed and my own child and another child needed it equally, I would flip a coin to decide. She was enraged. She believed that her child's needs would warrant greater moral weight because she had a special relationship with her. This question, whether a special relationship or distributive justice should prevail, occurs widely and may become problematic. Such parents' unwillingness to accept any place for a principle of distributive justice may become problematic, for example, when they are asked to accept being in a queue. "Why didn't they tell me earlier so that my daughter could be first on the list," this same parent raged. She, literally, could not comprehend that she was not given special information, because others deemed her daughter's needs to be equal to the needs of others. This mothers' exceptional anger, paradoxically, harmed her daughter because the mother informed her daughter that others were against her.
10. In re K.I., District of Columbia Court of Appeals, Nos.98-FS-1683 and 98-FS-1767 (Decided 29 July 1999), 1700-42, p. 1724.
11. V.S. Ramachandran and S. Blakeslee, Phantoms in the Brain (New York: Quill, 1998), 61.
12. M.F. Small, Our Babies, Ourselves (New York: Doubleday, 1998).
13. D.J. Hales et al., "Defining the Limits of the Maternal Sensitive Period," Developmental Medicine and Child Neurology 19 (1977): 454-61. That the sensitive period is of limited duration may be biologically purposeful. It may have evolved through evolution for much the same reason that an animal infant will cry for only a limited time if its mother has been killed. The infant's crying forever could attract prey and reveal its location. Animal parents who cannot have contact with their infants for some reason or other, such as the infant's being injured or dying, may be free emotionally sooner to go on and survive.