The Federation Press

When Doctors and Parents Disagree

Ethics, Paediatrics and the Zone of Parental Discretion

Overview

In paediatrics, clinicians and parents sometimes disagree about the appropriate medical treatment for a child. Parents can prefer an option that differs from the clinician’s recommendation. When should the parents’ decision about their child’s medical treatment be overridden?

This book explores ethical decision-making when clinicians and parents disagree about medical treatment for a child. It develops and explores a concept called the zone of parental discretion: an ethical tool that aims to balance children’s wellbeing and parents’ rights to make medical decisions for their children. Written by experienced clinical ethicists and paediatric clinicians, this book offers ethical analysis and practical guidance based on real-life clinical cases. It aims to assist doctors, nurses, allied health professionals and clinical ethics staff to deal with these ethically challenging situations.

The book is divided into five parts:
        1.  An ethical tool: the zone of parental discretion
        2.  Roles of doctors and parents in decision-making
        3.  Clinicians encountering parental refusals
        4.  Clinicians encountering parental requests for treatment
        5.  Clinicians encountering parental requests for interventions on healthy children

Table of Contents

Acknowledgments
Notes on Contributors

Introduction
     Rosalind McDougall, Clare Delany and Lynn Gillam

Part I – An ethical tool: the zone of parental discretion

1.  The zone of parental discretion
     Rosalind McDougall, Lynn Gillam and Hugo Gold

2.  Within the ZPD: focusing on harm and children’s interests
      Rosalind McDougall, Lynn Gillam, Nikki Kerruish and Jeanne Snelling

Part II – Roles of doctors and parents in decision-making

3.  So, do we really need doctors anyway? Information, expertise and the changing dynamic between doctors and families
      Giuliana Antolovich

4.  Who should decide for critically ill neonates and how? The grey zone in neonatal treatment decisions
      Dominic Wilkinson

5.  Parental rights: who has them and what are their limits?
      Giuliana Fuscaldo

Part III – Clinicians encountering parental refusals

6.  The rehabilitation context: the ZPD and ongoing care questions
      Clare Delany and Barbara E Gibson

7.  When a parental refusal of treatment is only distantly or unpredictably life-threatening to the child
      Henry Kilham, David Isaacs and Ian Kerridge

8.  Parental discretion and medical tests for children
      Rosalind McDougall and Hugo Gold

Part IV – Clinicians encountering parental requests for treatment

9.  Parents seeking treatment that health professionals consider burdensome
      John Massie

10. Children with profound cognitive impairment: growth attenuation and the ZPD
      Nikki Kerruish and Jeanne Snelling

Part V – Clinicians encountering parental requests for interventions on healthy children

11. The ethics of performing elective appearance-altering procedures to alleviate or prevent psychosocial harms to the child: the case of paediatric otoplasty
      Lauren Notini

12. Genetic carrier testing in children
      Danya Vears

13. Parent-led request for female genital cosmetic surgery in an adolescent
      Merle Spriggs

Conclusion: the ZPD as an ethics education tool
      Clare Delany

Index

Of interest...