MARTAKIS, Kyriakos, BRAND, Helmut and SCHRÖDER-BÄCK, Peter, 2018. Developing autonomy in pediatric healthcare: towards an ethical model. In: ISSOP2018 - Early Childhood Intervention: Science, Systems and Policies - Promoting Healthy Development of Vulnerable Children [online]. Bonn, Germany: DGSPJ. 29 September 2018. p. 1–120. [Accessed 4 November 2018]. Available from: https://www.issop.org/cmdownloads/martakis-issop-2018/
Background: The “four principles” approach (respect for autonomy, beneficence, non-maleficence and justice) is well established in medical ethics analysis. However, a series of problems arises when applying this approach in social pediatrics, since the classical dipole (physician - patient) is replaced by a triangle of actors (child - pediatrician - parents) and the child’s autonomy is still developing. Aim: To frame a model describing developing autonomy in child’s healthcare while reflecting the “four principles” approach.
Method: Synthesis after literature study in a systematic fashion of four electronic databases (CINAHL, Pubmed, BELIT, WoS), focusing on i) the concept of autonomy referring to the absolute value of the autonomous individual, and ii) the age-driven process of reasoning and competent decision-making development.
Results: We summarized our findings developing a conceptual model that includes the child, the pediatrician and the parents. The pediatrician-child relationship is based on different forms of guidance and cooperation, resulting in varying levels of activity and passivity. Parental authority influences the extent of a child’s autonomy, based on the level of respect of the child’s moral equality. Finally, the child’s decision-making competence may be related to the child’s age. Driven by fiduciary interest or self-interest all actors aim at the maximization of the child’s medical good.
Discussion: The model maps norms, values and morally relevant conditions that elucidate the situation of pediatric care. Relevant contextual, existential, conceptual, and social-ethical conditions shall be considered when applying the model, to facilitate dialogue in social pediatrics, including social pediatricians, children and their parents.
Kyriakos Martakis, University of Cologne, Children’s and Adolescents’ Hospital, Cologne Germany and Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, the Netherlands
Helmut Brand, Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, the Netherlands
Peter Schröder-Bäck, Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, the Netherlands and Faculty of Human and Health Sciences, University of Bremen, Germany