Dickey Susan B, Kiefner Jeanne, Beidler Susan M
Department of Nursing, Temple University, College of Allied Health Professions, Philadelphia, PA, USA.
J Sch Nurs. 2002 Jun;18(3):179-86. doi: 10.1177/10598405020180031001.
This article supports the moral viewpoint that minors with decision-making capacity, regardless of their age, should be involved in their health care decisions. When clinical care proceeds without attention to a child's emotional and developmental potential, the needs of a young person to be socialized to take care of his or her health care from an early age are not met. This is ethically irresponsible. Developing competence for informed consent decisions is associated with cognitive capacity. Explicit federal guidelines and laws exist for the inclusion of minors in research. By contrast, minors are often left out of participating in the health care decisions that may affect them for a lifetime in illness and wellness preservation. For day-to-day care, respect for children as increasingly autonomous individuals, members of families, and society is derived from the ethical principle of autonomy. The school nurse is often in a unique position to promote this professional behavior because most interactions are directly with the minor and without parental presence. In addition, the health office is a "safe" place where students can go for a variety of concerns. The school nurse must be concerned about ethical practice while staying within the limits of state and federal laws regarding minors' consent to treatment and confidentiality.
本文支持这样一种道德观点，即具有决策能力的未成年人，无论其年龄大小，都应参与自身的医疗保健决策。当临床护理过程中不关注儿童的情感和发育潜力时，年轻人从小就被引导学会照顾自己医疗保健需求的需要就无法得到满足。这在伦理上是不负责任的。形成知情同意决策的能力与认知能力相关。联邦有明确的指导方针和法律规定未成年人可参与研究。相比之下，在可能影响他们一生健康与疾病防治的医疗保健决策中，未成年人却常常被排除在外。对于日常护理而言，将儿童视为日益自主的个体、家庭和社会成员加以尊重，这源于自主这一伦理原则。学校护士往往处于独特的位置来促进这种专业行为，因为大多数互动是直接与未成年人进行且无家长在场。此外，医务室是学生可以因各种问题前去的“安全”场所。学校护士在遵循州和联邦关于未成年人同意治疗及保密的法律规定的同时，必须关注伦理实践。
