'Emotional tension' when parents' wishes overridden

Associate Prof Lynn Gillam, a specialist in health ethics at the University of Melbourne,...
Associate Prof Lynn Gillam, a specialist in health ethics at the University of Melbourne, discusses 'the ethics of decision-making' involving children, at a bioethics conference in Dunedin yesterday. Photo by Gregor Richardson.
Long-term effects on family relationships should be considered before doctors seek a court order to override parental wishes over a child's medical treatment.

That view was expressed on Friday by Associate Professor Lynn Gillam, who is a clinical ethicist and academic director of the Children's Bioethics Centre at the Royal Children's Hospital, Melbourne and an associate professor in health ethics at the University of Melbourne.

Prof Gillam was commenting during a plenary talk on ''When parents and doctors disagree about medical treatment for a child: the ethics of decision-making'' at the New Zealand Bioethics Conference, hosted by the University of Otago Bioethics Centre.

One key issue concerned the ''ethical weight to be given to the views of parents'' when they and doctors disagreed about treatment or management.

She also noted in an interview that ''the emotional tension can be really high'' in such circumstances.

During a later question and answer session, a questioner suggested there was a risk of parents removing their child from the hospital and ''never seeing them again'', after such a disagreement. Prof Gillam said the potentially adverse long-term effect of tensions within a family and other conflicts resulting from disagreements over treatment also had to be taken into account.

Disagreement could take place over many different matters, with parents who were Jehovah's Witnesses refusing to allow their children to have blood transfusions ''perhaps the most familiar example''.

But parents could refuse '' all sorts of treatment'' for children, including chemotherapy for cancer and insertion of catheters or lines.

The first response by medical staff should always be ''to understand and discuss, but agreement or compromise cannot always be reached.''

She discussed using the concept of the ''Zone of Parental Discretion'' as a tool in deciding what ethical weight to give to parental views.

Parents were recognised legally and ethically as decision-makers for their children, but ''the authority of their decisions is not unlimited''.

Where serious harm, including loss of life, could result from a parental decision, parental discretion should be resisted or overridden, she said.

- john.gibb@odt.co.nz

Add a Comment