Reasons to Amplify the Role of Parental Permission in Pediatric Treatment

Abstract

Two new documents from the Committee on Bioethics of the American Academy of Pediatrics (AAP) expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the importance of informed and voluntary parental involvement in pediatric decision making. This article provides a more expansive account of the value of parental permission. In particular, we suggest that an expansive role for parental permission may (1) reveal facts and values relevant to their child's treatment, (2) encourage resistance to suboptimal default practices, (3) improve adherence to treatment, (4) nurture children's autonomy, and (5) promote the interests of other family members.

Keywords:

• autonomy
• informed consent
• best interests standard
• harm threshold
• parental permission
• pediatrics

This article is referred to by:

Integrating Informed Nondissent Into Informed Consent Standards

Can Families Have Interests?

Permission to Speak? Voices in Pediatric Decision Making

Expanding Parental Permission in Pediatric Treatment: A Hasty Generalization

Children Are Not the Property of Their Parents: The Need for a Clear Statement of Ethical Obligations and Boundaries

A Dose of Paternalism: How Eliciting Values, Not Amplifying Parental Permission, Can Promote the Interest of Children and Families

Parental Permission in the Context of Family-Centered Care

Minimizing the Child's Interests by Focus on Parental Values and Identities

Harm and Parental Permission: A Response to Our Critics

Notes

1. Reasonable people can disagree about what constitutes best medical practice, and consequently, they can also disagree about what constitutes suboptimal practice. However, in the context of this section, we use “suboptimal” to characterize situations in which there is wide consensus about what course of action is best, and yet something other than this option is chosen, for example, with predictably worse outcomes or less efficacy than other options would have offered.

2. It is worth noting that our argument seems to go a step further than the one offered by Liao, Savulescu, and Sheehan (2007), according to which pediatric treatment decisions that benefit parents can be justified, even if they do not promote the child patient's best interests, on the grounds that parents should not be forced to make unreasonable sacrifices to promote their children's best interests.