posted
Dag, my own answers, with the knowledge that there's no perfect answers.
quote:Originally posted by Dagonee: How do the child's wishes factor into this? We generally don't let children make all the same decisions we allow adults to make, especially when their lives are threatened. If the child knew (confirmed in whatever manner you wish to use) that she would likely die without the treatment yet chose to refuse it, should we let her refuse?
It depends on how old the child is, for one. In general, I would say that if the child is in their mid-to-late teens, I would be inclined to let them make the choice. For practicalities sake, call it the age where they could legally be emancipated in their jurisdiction. Let them go before a Family Court judge, the same sort of judge that would hold their emancipation hearing, and make their case. If that person holds they are competent to make decisions for their own medical care, so be it.
I think in most places that age is 14 or 15. I'd be uncomfortable with giving blanket responsibility for their own medical decisions to anyone younger than that. For those younger, I'd stick with the "reasonable adult" standard. Would a reasonable adult be likely to accept or refuse this treatment? In your hypothetical 1, I think a reasonable adult would be likely to take the treatment at doubling from 25% to 50%, less likely at 10% to 20%. But who makes that judgement? How about we look at the statistics of how many people accept and refuse treatment at those odds each year? A treatment that 75% of patients in the same situation opt for? Require it. One that 75% of patients refuse? Don't. Ask a statistician to draw the line of where "average" is based on the distribution of answers.
Situation 2 is hard. I'm a 50/50 girl myself, and if there's a better than 50% chance she'd survive I'd say it isn't a a danger of imminent death situation where the state should be intervening, except for to find and prosecute whoever impregnated her. But, so then what do I say when you say okay, make it 60% chance of death? I would want a trained counselor involved in the situation for sure, to try to determine if she really understands the consequences. I can tell you that at 75% I'm definitely in favor of forcing the abortion, but that's at least party because that's about where my own risk analysis would change if it was me. Between 50% and 75%? I don't know.
3), again for children too young to be emancipated, no, the child cannot refuse the treatment. Because if we're assuming the current laws, then we're also assuming the current stem cell compromise, only using approved lines that didn't come from aborted fetuses. I feel fine saying a child under the age of 14 or 15 isn't competent to make that decision and that the majority of adult Americans would accept the treatment.
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quote:Originally posted by The Pixiest: Actually, isn't NOT taking your kids to the doctor rather INactive?
Creating an atmosphere of hostility towards gay people is rather active.
Parents are legally required to provide their underage children with basic physical necessities such as food, shelter and medical care.
There are no laws requiring parents to provide their children with "emotional" necessities, perhaps their should be but I doubt any one of us could define emotional necessities in a clear and unambiguous way.
I'm general uncomfortable with "emotional abuse" because I think it is so poorly defined.
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quote:It depends on how old the child is, for one. In general, I would say that if the child is in their mid-to-late teens, I would be inclined to let them make the choice
I would agree that's an important factor. I'm not sure about tying it to emancipation, but the mechanics of guardian ad litem and family court likely work. I think the factors that have to be evaluated include the medical risks, the probability of treatment working, and the reason for refusal.
quote:How about we look at the statistics of how many people accept and refuse treatment at those odds each year? A treatment that 75% of patients in the same situation opt for? Require it. One that 75% of patients refuse? Don't. Ask a statistician to draw the line of where "average" is based on the distribution of answers.
I'm very uncomfortable with using what most people would do as the baseline. The problem, of course, is that I can't think of anything better right now.
quote:I can tell you that at 75% I'm definitely in favor of forcing the abortion
Not surprisingly, I strongly disagree. I can't really cypher out how much of that disagreement comes from my beliefs about how wrong abortion is and how much is about my feelings that the reason should count. Assuming someone thinks abortion is the intentional killing of a human being, I have a hard time forcing them to undergo the procedure. Note that I don't support making an abortion illegal in the 75% case.
quote:again for children too young to be emancipated, no, the child cannot refuse the treatment. Because if we're assuming the current laws, then we're also assuming the current stem cell compromise, only using approved lines that didn't come from aborted fetuses
The approved line requirement only applies to federal funding.
quote: I feel fine saying a child under the age of 14 or 15 isn't competent to make that decision and that the majority of adult Americans would accept the treatment.
Pretty much the same thing here, except that I think this highlights my problem with the "What would the majority do?" solution, because I suspect far fewer people would reject this treatment. However, the moral issue is exactly the same to many people.
It seems as if you don't factor the reason for refusal into your decisions, except to the extent that most people take it into account. That could be because it wasn't as explicitly called out in the hypotheticals, so I'm not sure my interpretation is correct.
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quote:Parents are legally required to provide their underage children with basic physical necessities such as food, shelter and medical care.
To expand a little, the failure to perform a legally required duty can fulfill the actus reus element of a crime - from the law's perspective, an omission of an legally required act is an act.
quote:I'm general uncomfortable with "emotional abuse" because I think it is so poorly defined.
And "poorly defined" means "easy to abuse."
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posted
The only way I would tie it to emancipation is by using the same age requirements. I think if we as a society say that someone at X age can, after evaluation by a judge, be found competent to make their own decisions, then we can't rightly say that someone at the same age can't be found competent to make their own medical decisions through the same type of test.
I thought for a long time about using what most people would do as a baseline. The only other thing I came up with is a one-on-one evaluation with a counselor to determine if the child really understood the situation and the consequences. But there's several problems with that. One, I don't think a, say, 5 year old could meet that test, but there's definitely procedures I would allow a 5 year old's parent's to refuse for them. Two, then you get into the biases of the individual making the evaluation. I would rather go with a wider pool of what most people would do than let one person who is not the child's parent make the call.
For the most part, I'd rather the parent was making the call, of course. This would only come into play in the case of parents who refused all medical treatment. Perhaps it could be a team of doctors, or the hospital's ethics committee? Although the "pillow angel" case showed that those solutions can be quite flawed. Perhaps instead of using statistics based on the general population, we use them based on the decisions other parents have made for their minor children?
quote:Not surprisingly, I strongly disagree. I can't really cypher out how much of that disagreement comes from my beliefs about how wrong abortion is and how much is about my feelings that the reason should count. Assuming someone thinks abortion is the intentional killing of a human being, I have a hard time forcing them to undergo the procedure. Note that I don't support making an abortion illegal in the 75% case.
Like I said, situation 2 is hard. It was definitely the hardest of the three for me. another factor you didn't mention was what are the odds given on the baby surviving? If the odds are 40% that both the mother and the baby will die in the second trimester and the mother would live with the abortion, does that make a difference? 75%?
I considered including reason for refusal in my evaluations, but the only place I did was in wanting a trained counselor involved in situation 2. I didn't lay it out explicitly, but I would expect finding out and considering the reasons to be part of making sure the girl understood the situation and the consequences. For the most part, though, I left it out because I don't know how we judge what's a good reason and what isn't. We've already decided that the parents' reason isn't good enough, or we wouldn't be in this spot. How can we say they parents' reason isn't good enough, but the child's is? I don't think we can say it's okay to put a child's life in danger by allowing them to refuse medical treatment for reason Y but not for reason X. That gets back to Pix's line -- if you say it's not okay for other people's reasons, eventually someone's going to say it's not okay for your reason. I think we have to say either it's okay or it isn't.
Incidentally, in situation 2, if this was not a family that refused all medical treatment, I would let the family make the decision and wouldn't try to force the abortion on the girl regardless of the possible consequences. I am taking this strictly as applying to situations where decisions about the child's medical welfare have been removed from the parents because they don't believe in modern medicine for whatever reason. If they have been taking their daughter to the doctor regularly and when necessary, consult with the doctor when the girl becomes pregnant, and refuse the abortionand she does not object I'm fine with that decision. I do not think refusing the abortion alone is grounds for removing their parental rights.
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I know people who complain that they were emotional abused because their parents didn't praise them enough. Talk about diluting the meaning of the word abuse to a non-nonsensical level.
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quote:The only way I would tie it to emancipation is by using the same age requirements. I think if we as a society say that someone at X age can, after evaluation by a judge, be found competent to make their own decisions, then we can't rightly say that someone at the same age can't be found competent to make their own medical decisions through the same type of test.
That makes sense. I think there are situations where a child might not be ready to be emancipated but might be ready to make this kind of decision, though.
quote:This would only come into play in the case of parents who refused all medical treatment.
This changes my perception of your original post on the subject dramatically.
quote:Perhaps instead of using statistics based on the general population, we use them based on the decisions other parents have made for their minor children?
I'm still uncomfortable with this, but less so. Based on my prior understanding, there didn't seem to be room for medical decisions made outside the mainstream. So my biggest objection is gone.
There are other objections, some of which you've pointed out yourself (difficulty of determination, for example).
quote:Perhaps it could be a team of doctors, or the hospital's ethics committee? Although the "pillow angel" case showed that those solutions can be quite flawed.
This brings up an ugly possibility - that continuing treatment might be abusive. I've seen arguments made that certain forms of aggressive treatment amount to child abuse in certain situations. I can see situations where it might be, but I have little doubt that some non-significant number of those decisions would be based on characteristics such as the presence of a disability (see pillow angel again).
quote:I considered including reason for refusal in my evaluations, but the only place I did was in wanting a trained counselor involved in situation 2. I didn't lay it out explicitly, but I would expect finding out and considering the reasons to be part of making sure the girl understood the situation and the consequences. For the most part, though, I left it out because I don't know how we judge what's a good reason and what isn't. We've already decided that the parents' reason isn't good enough, or we wouldn't be in this spot. How can we say they parents' reason isn't good enough, but the child's is? I don't think we can say it's okay to put a child's life in danger by allowing them to refuse medical treatment for reason Y but not for reason X. That gets back to Pix's line -- if you say it's not okay for other people's reasons, eventually someone's going to say it's not okay for your reason. I think we have to say either it's okay or it isn't.
I think there's a qualitative difference between a child putting herself in danger for an ethical (to her) reason and a parent putting the child in danger for an ethical (to them) reason.
I'm not particularly concerned about judging the reason to be good enough, but rather the child's understanding of the reason and the child's understanding of her medical condition, including the implications of treatment. Assume we had a perfect means of determining whether the child was really making a fully-informed decision. Then I would support the child's right to refuse insulin because she believes she should pray rather than receive medical treatment. At the same time, if we knew the child did not want to refuse treatment or didn't understand either the ethical or medical aspects of the situation, I would favor legal intervention to get her treatment.
We don't have that perfect information, of course. Therefore we will have errors going in both directions - treating when we shouldn't (according to the principle I've outlined above) and not treating when we should. I prefer a system that emphasizes avoiding the second type of error.
In making that determination, the reason stated by the child will be an important factor. And the perceived "quality" of the reason will make it more or less believable whether the reason is fully understood and sincerely held.
Obviously, the whole enterprise is fraught with peril.
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Ultimately, it sounds as if, given good parenting (for some definition of "good" we won't precisely express here), you favor allowing a child to refuse treatment for ethical reasons. I agree as a general principle. I think a good parent-child relationship will be a far more effective means of determining if the child understands the implications of her decision than any legal mechanism we could create.
I think we should still have such a legal mechanism, of course, and we should make it as good as it can be.
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quote: Two followers of a fundamentalist Christian church that favours faith healing over conventional medicine are to be prosecuted for manslaughter after their daughter died of a treatable infection.
Carl and Raylene Worthington were indicted by a grand jury in Oregon's Clackamas county following the death of their 15-month-old daughter Ava in March.
The toddler died of bronchial pneumonia and a blood infection, according to the state medical examiner's office - both conditions that could have been treated with antibiotics.
The parents, who surrendered to police on Friday, are members of the Followers of Christ, a fundamentalist church in Oregon with about 1,500 members. They were released on $250,000 (£126,000) bail.
quote:It depends on how old the child is, for one. In general, I would say that if the child is in their mid-to-late teens, I would be inclined to let them make the choice. For practicalities sake, call it the age where they could legally be emancipated in their jurisdiction. Let them go before a Family Court judge, the same sort of judge that would hold their emancipation hearing, and make their case. If that person holds they are competent to make decisions for their own medical care, so be it.
Just for clarification,14 year olds can consent to medical care in Alabama - medical consent laws vary by state.
From the Alabama code Section 22-8-4:
quote:Any minor who is 14 years of age or older, or has graduated from high school, or is married, or having been married is divorced or is pregnant may give effective consent to any legally authorized medical, dental, health or mental health services for himself or herself, and the consent of no other person shall be necessary.
They also have the right to refuse medical treatment, and as long as they are at least 14 the parent cannot override that - my husband has seen it come up when parents will call 911 and the child doesn't wish to go to the hospital. If they're 14, they can refuse treatment and he can't take them to the hospital. Or if they're pregnant - at any age (and yes, my hubby has treated pregnant girls who were under 14).
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posted
This topic has made a few turns since I left it! I just wanted to address one thing, though:
quote:Originally posted by MrSquicky: Christine, I don't see this ambivilence to requiring medical care for sick kids that you do. From my perspective, if a parent is depriving their kids of necessary medical treatment, this is considered by a majority of people as wrong and something the state should step in for. Though I'm not sure about this, my impression is that the legal issue is somewhat settled as well, that the state can force necessary medical treatment over parents' objections.
Ambivalence? I'm actually outraged that the people who are supposed to protect children didn't get this child care when it would have done her some good -- before sue died. But we (society) are reluctant to make those decisions for a parent for all the reasons Dag pointed out and more. So instead of making a decision (as a society) we're wishy washy about it, don't take action when it does any good, and then want to talk about punishment as if that will solve anything. It's the punishment I'm ambivalent about -- not the medical care. We won't make up our mind whether something is right or wrong and then we want to come around and punish a person for it after the fact? Well, I guess I'm not sure why that does anyone any good.
Parents cannot raise their children any way they want. They have quite a bit of latitude, but we have stepped in and said no to certain things -- such as starving them. We haven't said no to no medical care, possibly because we don't want to step on the toes of religion.
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posted
Christine, I'm puzzled by your reaction. What do you think I mean when I'm talking about ambivalence?
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Yikes. Indeed you're right. I just saw this in my RSS feeds and I assumed it was the same case. It didn't really come to my mind that something so similar would have happened/been reported twice this close together.
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quote:Originally posted by MrSquicky: Christine, I'm puzzled by your reaction. What do you think I mean when I'm talking about ambivalence?
I guess I thought that you thought (wow that's awkward ) that I wasn't sure whether parents should be required to get medical treatment for their children. I am definitely of the opinion that parents should be required to get life-saving medical care for their children.
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No, I was talking about the general public. The problem with these cases, as far as I can tell, is not that people feel two ways about them, but, generally, that people don't know about them. Where you see wishy-washy no decision making, I see the idea that whackos should be prevented from killing their kids by denying them medical care as being widely accepted.
But how do you tell when this is happening?
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Oh, I see...and that does answer the question of what purpose punishment solves. If we can't always detect when these things are happening, then punishment shows others who are living the same lifestyle that such behavior is unacceptable. Thus potentially preventing another such case.
Still, it seems to me that every time this topic comes up people debate whether or not we should force parents to get medical care for their children. And if so, under what circumstances? Do we require yearly physicals? If not, many things may get missed anyway. Do we just require treatment when they're sick? How sick? If my son gets a cold, I don't always call the doctor.
One thing that has always bothered me about this area of law is the ambiguity. When has a parent crossed the line? What measure do we use? Actions (ie no checkups) or results (ie child dies)?
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quote:Still, it seems to me that every time this topic comes up people debate whether or not we should force parents to get medical care for their children. And if so, under what circumstances? Do we require yearly physicals? If not, many things may get missed anyway. Do we just require treatment when they're sick? How sick? If my son gets a cold, I don't always call the doctor.
But the discussions are mostly about drawing a line, and I seldom see anyone draw such a line that comes close to the news stories that trigger the discussions.
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posted
With the exception of some hard core libertarians, most people believe that it takes a village to raise a child and therefore the entire community and not solely the parents has some responsibility for its children.
I also think that with very few exceptions, most people feel that children's needs are best met by loving caring parents. As a result most of us feel that the community's responsibility to its children is best filled by providing support for the parents and intervening only when parents are in violation of community values.
In a monoculture, that balance is easy because nearly all members of the community share the same value system and standards for acceptable parenting are well established in tradition.
Unfortunately, that isn't at all an accurate description of our society. Our culture isn't just culturally diverse,our values and standards are also in flux. Even if you look at a very narrow slice of our society (say my family) you see an enormous diversity in what is considered good parenting. The change that has occurred over three generations (my grandparents, my parents and then my syblings) is truly remarkable.
When you extend that to the entire community it is no mystery that we are struggling with these issues. There is no easy simple answer to how to balance the communities responsibilities with the parents rights.
There are two easy extreme solutions. 1. The community assumes full responsibility for the child, negating all parental rights. Perhaps raising all children in some sort of communal boarding school.
2. The community abdicates all responsibility for its children allowing the parents the right to do whatever they see fit even if that means severe neglect or even murder.
I hope I'm right when I say that very few of us would feel comfortable with either of those extremes even if they are the simplest solutions. I think our consciences tell us that both are wrong and so we must continue to grapple with the middle ground even if we do not have clear answers.
[ April 01, 2008, 05:14 PM: Message edited by: The Rabbit ]
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Circumstantially, neither extreme seems to be the simplest solution, just the easiest solutions to write down hypothetically.
Typically the most workable solution is to have law enforcement structures in place to take children away from abusive and/or neglectful parents, and make it a communal cost to pay for this structure and foster care.
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quote:Typically the most workable solution is to have law enforcement structures in place to take children away from abusive and/or neglectful parents, and make it a communal cost to pay for this structure and foster care.
And that solution becomes extremely complicated when you try to define what constitutes abuse or neglect in a society with diverse values and standards. Which was the entire point of my post.
But you will note, I absolutely did not endorse either of the simply defined extremes. The fact that defining abuse and neglect is a challenge does not absolve us of the ethical responsibility to keep children from being abused and neglected.
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It is interesting to read this thread in the light of the rescue of children from the compound in Texas.
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) that I wasn't sure whether parents should be required to get medical treatment for their children. I am definitely of the opinion that parents should be required to get life-saving medical care for their children.
