When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity

Winters Janine Penfield

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When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity

机译：当父母拒绝时：在不确定和复杂性的情况下解决父母和临床医生之间的根深蒂固的分歧

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When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle (HP) and the zone of parental discretion (ZPD). Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key questions. I outline and defend a new decision-making tool that includes three parts: identifying the nature of the disagreement, checklists for key elements of the HP and ZPD, and a "think list" of specific questions designed to enhance use of the HP and ZPD in clinical decision making. These tools together will assist those embroiled in complex disagreements to disentangle the issues to find a path to resolution.

机译：当共享决策违反和父母和医疗提供者发出根深蒂固和相互矛盾的观点时，需要道德框架来找到前进的方向。本文审查了对最佳利益标准的思想的演变，然后讨论了危害原则（HP）和父母自由裁量区域（ZPD）的优势。在复杂性和不确定性的情况下将这些框架应用于父母拒绝提出了需要具体的子步骤分析大局并确定关键问题的挑战。我概述并捍卫一个新的决策工具，包括三个部分：识别分歧的性质，HP和ZPD的关键要素的清单，以及旨在增强HP和ZPD的使用的“思想列表” 在临床决策中。这些工具在一起将帮助那些刺激复杂的分歧，以解除问题以找到解决方案的问题。

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来源
《American journal of bioethics》 |2018年第8期|共12页
作者
Winters Janine Penfield;
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作者单位

Univ Otago Ctr Bioeth 71 Fredrick St Dunedin 9054 New Zealand;

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原文格式 PDF
正文语种 eng
中图分类生物科学;道德与科学技术;
关键词
children and families; decision making; parental refusals; pediatrics; risk/benefit analysis;

机译：儿童和家庭;决策;父母拒绝;儿科;风险/效益分析;

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When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity

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