The Role of Parental Capacity for Medical Decision-Making in Medical Ethics and the Care of Psychiatrically Ill Youth: Case Report

Abstract

Introduction: Parents/legal guardians are medical decision-makers for their minor children. Lack of parental capacity to appreciate the implications of the diagnosis and consequences of refusing recommended treatment may impede pediatric patients from receiving adequate medical care. Child and adolescent psychiatrists (CAPs) need to appreciate the ethical considerations relevant to overriding parental medical decision-making when faced with concerns for medical neglect. Methods: Two de-identified cases illustrate the challenges inherent in clinical and ethical decision-making reflected in concerns for parental capacity for medical decision-making. Key ethical principles are reviewed. Case 1: Treatment of an adolescent with an eating disorder ethically complex due to the legal guardian's inability to adhere with treatment recommendations leading to the patient's recurrent abrupt weight loss. Case 2: Questions of parental decisional capacity amid treatment of an adolescent with schizoaffective disorder raised due to parental mistrust of diagnosis, disagreement with treatment recommendations, and lack of appreciation of the medical severity of the situation with repeated discharges against medical advice and medication nonadherence. Discussion: Decisions to question parental capacity for medical decision-making when risk of imminent harm is low but concern for medical neglect exists are controversial. Systematic review of cases concerning for medical neglect benefits from the assessment of parental decisional capacity, review of ethical standards and principles. Conclusion: Recognition of the importance of parental decision-making capacity as relates to parental autonomy and medical neglect and understanding key ethical principles will enhance the CAP's capacity in medical decision-making when stakes are high and absolute recommendations are lacking.

Ethical Dimensions in Contemporary Medical Practices: A Systematic Review and Analysis of Diverse Perspectives

“…The systematic review analysis encompasses a range of studies within the realm of medical ethics, each delving into distinct aspects of healthcare practices and ethical considerations. In an effort to unravel the intricate ethical dimensions surrounding parental decision-making for adolescents with mental health issues, Bieber, et al undertook a case report analysis [6]. The study offered a nuanced exploration of parental capacity challenges, shedding light on the ethical complexities of overriding parental decisions.…”

“…However, the limitation lies in the case report's inherent narrow focus, hindering the generalizability of its findings. Moreover, the absence of a specific sample size diminishes the precision of the study's conclusions [6]. Liddell, et al embarked on a legal analysis journey, aiming to unravel the complexities of isolating residents in care and group homes during the COVID-19 pandemic.…”