Reasonableness as a Relational Principle: An Integrated Framework for Pediatric Decision-Making

We modified and applied the surrogate decision-making framework of Buchanan and Brock for pediatrics, and present an integrated framework of pediatric health care decision-making, specifying authority and intervention principles, 2 guidance principles, and an additional category of relational principles, governing stakeholder interactions.

[The law to combat violence against women]

Concern about the issue of violence against women emerged in society in the second half of the 20th century. The development of networks of associations favours the creation of laws to defend women's rights on a national level and to respond to the European convention. While it is not easy for victims to assert their rights, a protection order is a key tool for protecting women. Through their actions, health professionals can facilitate the use of existing mechanisms.

Swiss neonatal caregivers express diverging views on parental involvement in shared decision-making for extremely premature infants

AIM

Due to scarce available national data, this study assessed current attitudes of neonatal caregivers regarding decisions on life-sustaining interventions, and their views on parents' aptitude to express their infant's best interest in shared decision-making.

METHODS

Self-administered web-based quantitative empirical survey. All 552 experienced neonatal physicians and nurses from all Swiss NICUs were eligible.

RESULTS

There was a high degree of agreement between physicians and nurses (response rates 79% and 70%, respectively) that the ability for social interactions was a minimal criterion for an acceptable quality of life. A majority stated that the parents' interests are as important as the child's best interest in shared decision-making. Only a minority considered the parents as the best judges of what is their child's best interest. Significant differences in attitudes and values emerged between neonatal physicians and nurses. The language area was very strongly associated with the attitudes of neonatal caregivers.

CONCLUSION

Despite clear legal requirements and societal expectations for shared decision-making, survey respondents demonstrated a gap between their expressed commitment to shared decision-making and their view on parental aptitude to formulate their infant's best interest. National guidelines need to address these barriers to shared decision-making to promote a more uniform nationwide practice.

Healthcare organizations and high profile disagreements

In this paper, we examine healthcare organizations' responses to high profile cases of doctor-parent disagreement. We argue that, once a conflict crosses a certain threshold of public interest, the stakes of the disagreement change in important ways. They are no longer only the stakes of the child's interests or who has decision-making authority, but also the stakes of public trust in healthcare practitioners and organizations and the wide scale spread of medical misinformation. These higher stakes call for robust organization-level responses. There are responsible and thoughtful ways for healthcare organizations to directly engage with these cases. Hospitals should seek an alliance with the parents around the goal of public discussion and utilize web-based platforms to provide the public with information about medical conditions, experimental treatments, and how clinical ethics deliberation in hospitals works. We outline five important lessons for healthcare organizations to keep in mind when responding to such cases. Approached with care, these cases could become "teachable moments" for both healthcare organizations and society.

Conflict between Children's Autonomy and Protection in Healthcare. Comparative Study between Spanish and Belgian Law

This article addresses the autonomy of children and adolescents in healthcare decisions, focusing on those ones that might entail a risk to the child's life or health, especially when a medical intervention is refused. In these cases, a conflict between the recognition of the autonomy of the child and his or her protection arises, and various legal systems solve it in different ways. This study examines this issue from a comparative perspective between Belgian and Spanish laws, taking into account that the latter was rewritten in 2015 to leave out all underage patients' decisions that could constitute a risk for their life or health.

Parenting Styles and Parent-Adolescent Relationships: The Mediating Roles of Behavioral Autonomy and Parental Authority

The parent–adolescent relationship has been a classic research topic, and researchers have found that parenting styles (e.g., authoritative, authoritarian) are closely related to various qualities of parent-adolescent relationships (e.g., cohesion, conflict). However, little empirical work has addressed how these variables correlate with each other in mainland China, nor has prior research addressed internal psychological mechanisms. The present study investigated the associations between parenting styles and parent–adolescent relationship factors, examined the mediating effects of adolescents’ expectations of behavioral autonomy and beliefs about parental authority, and explored whether adolescent gender moderated these effects. Results from a sample of 633 Chinese adolescents (7th grade: M_age = 13.50 ± 0.62 years, 9th grade: M_age = 15.45 ± 0.67 years, 11th grade: M_age = 17.30 ± 0.75 years) suggested similar levels of parent–adolescent conflict frequency for all parenting styles. However, for parent–adolescent conflict intensity, youth of neglectful and authoritarian parents reported higher levels compared to those with indulgent parents. The highest levels of cohesion with both parents were reported by adolescents with authoritative parents, followed by indulgent, authoritarian and neglect parenting styles. Cohesion with mothers for youth with authoritative or indulgent mothers was higher for girls than boys. Adolescents’ expectation for behavioral autonomy mediated the links between parenting style and conflict, whereas adolescents’ beliefs about the legitimacy of parental authority mediated the links between parenting style and cohesion; some of these mediating effects differed by gender. Findings highlight the importance of studying potential effects of adolescents’ values and attitudes within the family system in specific cultural contexts.

[Not Available]

When it comes to medical care, the move from minor to adult status is problematic, between the age of puberty and the age of majority, which only allows decisions to be taken independently. Medical law has evolved over the last few years, propelled by the promotion of child rights. It gives more space for adolescents to decide about their own health.

[The protection of children exposed to intimate partner violence]

Intimate partner violence is one of the most serious forms of abuse inflicted on children. It poses a challenge for professional practices. The protection of the child cannot be separated from that of the parent suffering the abuse, and their safety cannot be assured without an adapted arrangement of the conditions of parental authority.

[Teenage pregnancies, legal aspects]

Minor girls are legally considered as incapable, under the authority of their parents. Difficulties can arise when a minor becomes pregnant. The law takes account of this situation: under certain conditions, she can decide by herself to undertake certain actions, medical or otherwise, without the consent of her parents. These include access to contraception, abortion or anonymous birth.