Lang Abigail, Paquette Erin Talati
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Semin Neurol. 2018 Oct;38(5):533-538. doi: 10.1055/s-0038-1668078. Epub 2018 Oct 15.
When caring for minors, the clinician-patient relationship becomes more ethically complex by the inclusion of parents in the clinician-parent-patient triad. As they age, children become more capable of participating in the decision-making process. This involvement may lead them to either accept or refuse proposed care, both of which are ethically acceptable positions when the minor's capacity to participate in decision making is carefully considered in the context of their age, development, and overall health. Certain conditions may be more likely to impact their capacity for participation, but it is important for clinicians to avoid categorical presumption that minors of a certain age or with certain conditions are incapable of participating in decisions regarding their care. Understanding the ethical bases for decision making in pediatric patients and considerations for the involvement of minors who both assent to and refuse proposed treatment will equip clinicians to respect the growing autonomy of minor patients.
在照顾未成年人时，由于家长被纳入临床医生-家长-患者三元组中，临床医生与患者的关系在伦理上变得更加复杂。随着年龄的增长，儿童参与决策过程的能力越来越强。这种参与可能导致他们接受或拒绝提议的治疗，当在未成年人的年龄、发育和整体健康背景下仔细考虑其参与决策的能力时，这两种立场在伦理上都是可以接受的。某些情况可能更有可能影响他们的参与能力，但临床医生必须避免一概而论地假定某个年龄或患有某些疾病的未成年人没有能力参与有关其治疗的决策。了解儿科患者决策的伦理基础以及对同意和拒绝提议治疗的未成年人参与决策的考量，将使临床医生能够尊重未成年患者日益增长的自主权。
