Leonardo Angiulo: Medical Decision-Making in the Case of Children
Monday, January 13, 2014
Who Calls the Shots?
Who you choose to make those decisions for you can be addressed ahead of time with some simple forms. A health care proxy is a common document used to establish which one of your relatives or loved ones will be calling the shots. Of course, there is a significant segment of the population that hasn't, or shouldn't, dwell on worst case scenarios; namely, children. It is also true, however, that none of us get to decide what the world has in store for us.
Typically, parents of minor children are charged with making health care decisions for their children. This responsibility is a part of the principle known as “legal custody” of a minor child. Parents who are divorced or never married are probably much more familiar with this label, but any parent can understand the idea. Legal custody is defined by section 31 of chapter 208 of the Massachusetts General Laws to be the right and responsibility of parents to make major decisions regarding the child's welfare on such topics as education, religion and medical care.
There as many opinions on how to raise children as there are parents in world. Everyone has their own version of what is right for their family. And while there are important limits, for example you can't physically abuse a kid and call it discipline, so long as you are acting in the best interests of the child your rights as a parent are generally inviolable.
The recent case from California regarding Jahi McMath and her tragic complications from surgery presents the kind of worst case scenario no parent should have to face. Ms. McMath is a 13 year old who, according to major news sources, is on a ventilator, has no brain activity and may or may not be attached to a feeding tube. Her parents are left with the responsibility to decide whether to maintain life support or not.
The legal question presented by this scenario can be described with a few words on paper: who's choice is it to make. The depth of the issue to be decided is, however, limitless. How and when a person makes a decision about continuing life support will be different for everyone. The decision could be informed by religious teachings, may be influenced by family conversations before the surgery, or could come as a result of reflections on the medical opinion for a given case. Just like the people that the decision is made for, each situation is unique.
Unlike many legal issues, there is no elemental analysis or balancing of equities to make this decision for you. The legal authority of parents to make decisions on behalf of their children is very, very broad for a good reason: there is no one else qualified to make those decisions.
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