What’s in the best interests of the child?

Categories: Care.

The parent’s role as a decision maker is sometimes questioned if they disagree with doctors recommended treatment for their child. This is the case with Oshin Kiszko, a six year old boy with brain cancer. Oshin’s doctors believe he should receive curative treatment whereas his parents believe that the potential benefits of treatment don’t justify the terrible side-effects and the possibility of long-term health issues. Oshin’s parents would like him to receive palliative care to ensure a good quality of life in his remaining months.

In March, Oshin’s case was reviewed in Western Australia’s Family Court. The court ruled that Oshin be given chemotherapy. After another two court cases, the court supports a palliative approach for Oshin as the chances of a cure have decreased significantly. Oshin’s case is unique as most disagreements between parents and doctors are resolved in the hospital and don’t reach court.

Parents are usually the medical decision-makers for their children for ethical reasons, also because they will bear the burden of the medical decisions made for their children. Parents know their children best, this knowledge is crucial because alongside the clinical expertise of doctors, there is a better understanding of how a child may experience a particular medical treatment. However, the parental right to make medical decisions isn’t unlimited. The parents decision-making role is sometimes questioned when they don’t agree with the recommended treatment for their child.

Usually doctors act in the child’s best interests which means they do what will have the best possible outcome for the child, there are two fundamental problems with this approach. Firstly, a child’s well-being is made up of different elements, and there is no way of calculating well-being and comparing it across different treatment options to identify which option would be best. Secondly, this approach does not acknowledge parental autonomy. When there is disagreement between doctors and parents, focusing on whether parents are making decisions based on what is best for the child is ethically problematic. Doctors need to strike a balance between the child’s well-being and the parent’s autonomy by accepting inferior choices, as long as they are not harmful to the child. To read this full article, click here.