Quist Norman
Executive Editor and Publisher of The Journal of Clinical Ethics.
J Clin Ethics. 2019 Fall;30(3):240-246.
What process ought to guide decision making for pediatric patients? The prevailing view is that decision making should be informed and guided by the best interest of the child. A widely discussed structural model proposed by Buchanan and Brock focuses on parents as surrogate decision makers and examines best interests as guiding and-or intervention principles. Working from two recent articles by Ross on "constrained parental autonomy" in pediatric decision making (which is grounded in the Buchanan and Brock model), I discuss (supportively) features of Ross's effort vis-a-vis the best interest standard. I argue that any pediatric decision-making model that brackets or formally limits an engagement with the child patient assumes too much. Further, any model that under appreciates the place of parents and their autonomy, and the dynamic parent-child relationship, misses an opportunity to broaden the clinical encounter by considering questions of justice for the child (Rawls) and within a family (Ross). In this context, I focus on the child's emerging and ongoing emotional and intellectual development and autonomy¬-their capabilities and identifying primary goods.
对于儿科患者而言，应该由什么过程来指导决策呢？普遍的观点是，决策应该基于儿童的最大利益并受其指导。布坎南和布罗克提出的一个被广泛讨论的结构模型将重点放在作为替代决策者的父母身上，并将最大利益作为指导和/或干预原则进行审视。基于罗斯最近关于儿科决策中“受限的父母自主权”的两篇文章（其以布坎南和布罗克的模型为基础），我（持支持态度地）讨论罗斯在最大利益标准方面所做努力的特点。我认为，任何将与儿童患者的接触排除在外或正式加以限制的儿科决策模型都过于主观。此外，任何没有充分认识到父母的地位及其自主权以及动态的亲子关系的模型，都错失了通过考虑儿童（罗尔斯）以及家庭内部（罗斯）的正义问题来拓宽临床接触范围的机会。在此背景下，我关注儿童正在出现和持续的情感、智力发展及自主性——他们的能力以及确定首要善。
