Summary of "Conflict in the Pediatric Setting: Clinical Judgement vs. Parental Autonomy" by Amnon Goldworth

1. Physicians cannot be ordered to act contrary to their best medical judgement.

2. However, the physician's expertise is in diagnosis and prognosis, not the choice of ends or goals.

3. Therefore, the physician's clinical judgement does not eliminate the need to take the patient or surrogate's desires or values into account.

Futility needs to be viewed in this light. The autonomy of the patient or surrogate is pitted against the expertise of the physician when the patient/surrogate requests treatment that is judged to be futile by the physician. However, this judgement assumes a certain goal or end. Given the argument above, the health care team should work with the family to identify goals. Conflict can still occur if...

1. the family won't accept that their goal is unattainable,

2. the health care team judge the family's goals as inappropriate,

or...

3. the family's goals cannot be achieved without undue risk to others.

Parental Autonomy is important because:

1. family members are legally and morally responsible for raising a child. Decisions made now have the potential for affecting them for the rest of their lives.

2. Respecting the autonomy of the parents and their responsibility for ongoing care is the primary means of promoting the rights of the incompetent child.

3. Unless there is clear evidence to the contrary, the interests of the child will be of central concern to the family. Unless there is evidence of parental incompetence or ignorance, neglect or abuse, interference in the decisions of parents is unwarranted.

The physician can override the wishes of the patient or surrogate if treatment fails to achieve its physiological goals.

Resource:

Goldworth, Amnon. Stevenson, David K. “Conflict in the pediatric setting: clinical judgment vs. parental autonomy.” [and commentary] Cambridge Quarterly of Healthcare Ethics. 4(1): 3643, 1995 Winter.