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11/16/2017

Enhancing Pediatric Decision-Making: Australian Law Allows Children to Complete Advanced Directives

It always interesting to see how different countries handle pediatric decision-making in health care. For example, Australia now has shifted more towards respecting minors’ autonomy with its recent legislation. I first heard about this law during the Legal Update at the American Society of Bioethics and Humanities Annual Meeting this past October. The new law in Victoria, Australia coming into effect in March 2018 will require physicians to honor advanced directives written by children. Any child with capacity will be allowed to write their own advanced directives. There is no age limit as for who can write an advanced directive. The advanced directives must still be signed and witnessed, like adult advanced directives, and one of the witnesses must be a medical practitioner who must certify the person appears to have decision-making capacity and understands the effect of statements made.

This law will in essence create a situation where substituted judgment standard of decision making may become applicable. Traditionally, we use best interests’ standard for decision making in children because they are presumed to lack capacity and therefore can not make valid past preferences. However, if an advanced directive written by a child is valid, then we would have valid preferences and some evidence in order to navigate substituted judgment on behalf on the child patient. This will expand decision-making standards for children as well as avoid concerns of parents not having best interests of the child in mind.

This law will also call into question the practice of using assent verse consent for minors. The law is giving weight and value to a written stated preference but yet, we may not be honoring the verbal preferences of those same individuals. For example, a 15-year-old could write an advanced directive that would be valid but verbal consent for that same 15-year-old may not be valid if we are operating under the same traditional parental authority/ child assent model. It reinforces the age-old presumption that a written preference is more valid than a verbal preference, simply because it can last the trial of time and is an easier form of evidence to prove. Granted, the design of advanced directives is to govern in the future when the individual loses capacity. However, advanced directives also operate under the premise that the individual completing them have capacity to do so, implicitly also the capacity to consent to treatment. This new law gives children some authority for their future selves but no authority around their current selves.

For those in favor of including children in the health care decision making process, this seems like a great idea. This may also seem like a great idea for proponents of increasing advanced health care planning. However, it some ways this exacerbates the issues raised both in considering pediatric decision-making and honoring advanced directives. For example, should an adolescent patient make decisions for their future adult self (the unresolvable question of how much control the present self should have over the future self)? This seems more applicable to the pediatric population as developmentally adolescents are changing so much over a short period of time (in comparison to a lifespan). Having such a law makes sense for terminally-ill mature minors with capacity who may not live for a full lifespan, assuming of course they have contemplated, understand, and appreciate their medical circumstances. What a child may want one day may dramatically change the next. It is a step forward to properly enhancing children in health care decision making but it should be a cautionary step forward. Overall, this raises the question of how much autonomy is truly necessary for healthcare decision making. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and a Graduate Certificate in Clinical Ethics. For more information on AMBI's online graduate programs, please visit our website.

 

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11/16/2017

Love This Picture

I had the great pleasure of talking about out-of-pocket healthcare costs at Periodic Tables: Durham’s Science Café, a speaker series run by The Program for Science and Society at Duke University. The crowd was absolutely awesome, and much larger than … Continue reading

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11/15/2017

Obesity Nation!

Here is a picture, courtesy of the Financial Times, showing obesity rates among OECD nations. Only 5% of people living in Korea and Japan qualify as obese. Yet obesity rates are drastically higher in the United States; if someone’s in … Continue reading

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11/15/2017

Communicating about cancer: a need for a closer look at Patient Empowerment

This post is written in response to Ubel, Scherr and Fagerlin’s target article, “Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy” published in the November 2017 issue of The American Journal of Bioethics.


by Jonas Landers, MA

Ubel and colleagues describe what is obvious from much other academic and non-academic literature: Patient empowerment (PE) receives much attention – today and already for quite some time. This is true for PE not only regarding cancer, but particularly chronic conditions that require continuous efforts by those affected to deal with their situation. While both the attention for PE as well as its relevance are high, the authors rightly point towards its shortcomings in practice, i.e.…

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11/14/2017

Legal History of Medical Aid in Dying (video)

Here is a video of my presentation of the University of New Mexico Law School, "Legal History of Medical Aid in Dying." Other talks at UNM on MAID and on the role of state constitutions are here.   

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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

11/14/2017

Fordham University Ethics & Society Master’s Student Working to Eradicate Poverty

On October 17th, 2017, Omar Lebron, a graduate student of Fordham University’s Master of Arts in Ethics and Society program, moderated the event “Answering the Call of October 17 to end poverty: A path toward peaceful and inclusive societies” at the United Nations in New York to commemorate the 25th anniversary of the International Day for … More Fordham University Ethics & Society Master’s Student Working to Eradicate Poverty

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11/14/2017

Re-structuring the patient-provider communication process to empower patients

This post is written in response to Ubel, Scherr and Fagerlin’s target article, “Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy” published in the November 2017 issue of The American Journal of Bioethics.


by Susanne B. Haga, PhD

Most professional organizations have recommended a shift towards greater patient empowerment and shared decision-making. The result has been a data dump: An increase in the amount of information disclosed to patients.  For example, discussion of a prostate cancer diagnosis may include the grading and scoring, followed by discussion of three possible interventions, the risks and benefits of each, and information regarding recurrence rate, probability of adverse responses, costs, lost work time, follow-up care, and other information.…

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11/14/2017

9th International Shared Decision Making Conference (videos)

Videos of the plenary sessions from the 9th International Shared Decision Making Conference in Lyon are now available here.  

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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

11/14/2017

What is the purpose of Ethics Education?

by Craig Klugman, Ph.D.

Those of us who teach bioethics and ethics-in-general face a dilemma during every class session: How much of our own perspectives and analyses do we bring to the classroom? Is the role to be a mute facilitator—teaching students the mechanisms of ethical analysis but not judging the results of their conclusions—or to direct them to better arguments that might encourage them to accept our position on an issue? What is the goal of an ethics course: To teach how to think or to teach what to think? If we teach the former, then might students be led naturally to the latter?…

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11/13/2017

Teaching Better Communication: A Bootcamp Experience

This post is written in response to Ubel, Scherr and Fagerlin’s target article, “Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy” published in the November 2017 issue of The American Journal of Bioethics.


by Haavi Morreim, JD, PhD and Mark C. Bugnitz, MD

Communication is one of the most important skillsets in healthcare. As Ubel et al. describe in their American Journal of Bioethics article so well, inadequate communication can effectively deprive patients of the medical path that best fits with their personal goals and values – potentially leaving them, as in the example of prostate cancer, with an outcome that may be deeply dissatisfying.…

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