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Ethics of Child and Adolescent Palliative Care 

Ethics of Child and Adolescent Palliative Care
Chapter:
Ethics of Child and Adolescent Palliative Care
Author(s):

Robert C. Macauley

DOI:
10.1093/med/9780199313945.003.0013
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date: 20 August 2019

Over the course of childhood a patient’s decision-making capacity evolves. While eighteen is the age of majority in most states, younger patients may well have the ability to process information and make informed decisions. At the same time, the “dual process theory” of maturation reveals that emotional considerations may outweigh cognitive ones. Physicians must understand how to respond to parental requests for nondisclosure of diagnosis and prognosis, as well as differences of opinion between the patient and parents as to appropriate treatment options. Even when a child agrees with her parents regarding a treatment plan, this may reflect undue influence rather than voluntariness. And even when a treatment has a favorable benefit/burden ratio, an adolescent’s refusal may present such a logistical barrier that a modified treatment plan may need to be implemented.

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