Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
J Med Ethics. 2022 Jan;48(1):65-69. doi: 10.1136/medethics-2020-106120. Epub 2020 May 8.
Childhood obesity is an increasing health problem. Prior empirical research suggests that, although discussing lifestyle behaviours with parents could help prevent childhood obesity and its health-related consequences, physicians are reluctant to address parental responsibility in the clinical setting. Therefore, this paper questions whether parents might be (or might be held) responsible for their children's obesity, and if so, whether parental responsibility ought to be addressed in the physician-patient/parent encounter. We illustrate how different ideal-typical models of the physician-patient/parent interaction emphasise different understandings of patient autonomy and parental responsibility and argue that these models advocate different responses to an appeal for discussing parents' role in childhood obesity. We suggest that responsibility should be attributed to parents because of their parental roles in providing for their children's welfare. We also argue that whether, and how, this responsibility gives rise to a requirement to act depends on the parents' capacities. A deliberative-oriented physician-patient/parent interaction best captures the current ideals of antipaternalism, patient autonomy, and shared and evidence-informed decision-making, and might facilitate parental role development. We conclude that, while not discussing parental responsibility for childhood obesity in the clinical setting can be warranted in particular cases, this cannot be justified as a general rule.
儿童肥胖是一个日益严重的健康问题。先前的实证研究表明,尽管与父母讨论生活方式行为有助于预防儿童肥胖及其相关健康后果,但医生不愿意在临床环境中讨论父母的责任。因此,本文质疑父母是否可能(或应该)对其子女的肥胖负责,如果是这样,那么在医患/父母互动中是否应该解决父母的责任问题。我们说明了不同的医患/父母互动理想类型模型如何强调对患者自主性和父母责任的不同理解,并认为这些模型主张对呼吁讨论父母在儿童肥胖中的作用做出不同的回应。我们认为,应该将责任归咎于父母,因为他们在为子女的福利提供保障方面发挥了父母的作用。我们还认为,这种责任是否以及如何产生行动要求取决于父母的能力。以协商为导向的医患/父母互动最好地体现了当前反家长主义、患者自主性以及共同和基于证据的决策制定的理想,并且可能有助于父母角色的发展。我们的结论是,虽然在临床环境中不讨论儿童肥胖的父母责任在某些情况下是合理的,但这不能作为一般规则来证明。