a Seattle Children's Hospital.
b Goldkind Consulting LLC.
Am J Bioeth. 2018 Mar;18(3):4-9. doi: 10.1080/15265161.2017.1418921.
Inclusion of children in medical decision making, to the extent of their ability and interest in doing so, should be the default position, ensuring that children are routinely given a voice. However, optimizing the involvement of children in their health care decisions remains challenging for clinicians. Missing from the literature is a stepwise approach to assessing when and how a child should be included in medical decision making. We propose a systematic approach for doing so, and we apply this approach in a discussion of two challenging clinical cases. The approach is informed by a literature review, and is anchored by case studies of teenagers' refusal of clinical care, regulatory requirements for research assent, and the accepted approach to involving cognitively impaired adults in medical decisions.
在医学决策中纳入儿童，在他们有能力和兴趣的范围内，应该是默认的立场，以确保儿童有常规的发言权。然而，要优化儿童参与其医疗保健决策仍然是临床医生面临的挑战。文献中缺乏一种评估儿童何时以及如何应被纳入医疗决策的逐步方法。我们提出了一种系统的方法，并在对两个具有挑战性的临床案例的讨论中应用了这种方法。该方法的依据是文献综述，并以青少年拒绝临床护理的案例研究、研究同意的监管要求以及涉及认知障碍成年人参与医疗决策的公认方法为基础。
