Communicating with parents
Los Angeles County Bar and Medical Association’s Biomedical Ethics Committee guidelines for life-sustaining treatment of minors state that a parental decision should be honored unless there is "clear and convincing evidence" that the [parents’] decision is contrary to the child’s best interest and is "outside the current range of treatment practices."
In this situation, the guidelines spell out a process for communicating with the parents to try to understand the decision and for consulting with an ethics committee. If these options fail, the physician has the authority and obligation to refer the matter to the county agency responsible for children’s services, which will take it to juvenile court to have an appropriate surrogate appointed.
Throughout this process, caregivers must remain sensitive to the cultural and religious beliefs of the parents, says Vicki Michael, MA, JD, a professional mediator in Los Angeles. "We cannot dismiss the views of the parents without discussing them first."
Indeed, the guidelines state that even under circumstances in which a court has usurped parental authority, "the physician must be sensitive to the family’s cultural background and religious beliefs and should provide appropriate emotional support for the parents and the child."
The committee outlined a detailed communication process it hopes will address some of the situations that often lead to conflict. The communication strategies incorporate basic principles of dispute avoidance and resolution and address these three common issues:
• differences of opinion among pediatricians and specialists;
• refusal of parents to become surrogate decision makers;
• conflicting information about comfort care vs. aggressive therapy.
"Parents should be encouraged to hold, touch, interact with, and participate in the care of their child," the guidelines state.
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