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首页> 外文期刊>AJOB Primary Research >What Constitutes the Best Interest of a Child? Views of Parents, Children, and Physicians in a Pediatric Oncology Setting
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What Constitutes the Best Interest of a Child? Views of Parents, Children, and Physicians in a Pediatric Oncology Setting

机译：什么构成孩子的最大利益？儿科肿瘤学环境中父母，孩子和医师的观点

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Background: In pediatrics, the "best interest" standard has become the prevailing standard in decision making even though it proves difficult to apply in practice. Differences in values can lead to different views by families and physicians of what is in the interest of a child. Our aim was to gain insight into the views of parents, children, and physicians in a pediatric oncology setting. Methods: We conducted a qualitative multicenter study, using in-depth semistructured interviews, with 21 children aged 8–18 years undergoing cancer treatment, 26 parents, and 15 pediatric oncologists. Results: At the onset of treatment, parents, children, and physicians had the same views on what is in the interest of the child: survival by following the treatment protocol. In the course of treatment, however, a transition takes place. For families, what constitutes the best interests expands beyond medical considerations, to include the wish to lead a normal life, having control over certain aspects of treatment, and maintaining one's identity (e.g., through religion). These aspects sometimes collide with medical aspects, leading to different professional and familial views about what course of action is appropriate. Conclusions: In order to recognize personal views and avoid conflicts, physicians should explicitly discuss parent and family concerns and opinions in the course of treatment.We present a model of "communicative ethics" to make these issues a subject of discussion. The role of the family in determining what is in the best interest of the child should only be limited when it implies a substantial medical risk of (irreversible) harm to the child.
机译：背景：在儿科中，“最大利益”标准已成为决策中的通用标准，即使事实证明很难将其应用。价值观的差异会导致家庭和医生对儿童的利益有不同的看法。我们的目的是深入了解儿科肿瘤学环境中父母，孩子和医生的观点。方法：我们采用深入的半结构化访谈进行了定性多中心研究，对21名8-18岁的儿童进行了癌症治疗，26名父母和15名儿科肿瘤科医生。结果：在治疗开始时，父母，孩子和医生对儿童的利益有相同的看法：按照治疗方案生存。但是，在治疗过程中会发生过渡。对于家庭而言，构成最大利益的内容超出了医疗考虑，包括了过上正常生活，对治疗的某些方面有所控制并保持自己的身份（例如通过宗教）的愿望。这些方面有时会与医学方面发生冲突，导致就哪种行动方案合适而产生不同的专业和家族观点。结论：为了认识个人观点并避免冲突，医生应在治疗过程中明确讨论父母和家庭的关注和观点。我们提出了一种“沟通伦理”模型，以使这些问题成为讨论的主题。只有在家庭对儿童具有（不可逆转）伤害的重大医疗风险时，才应限制家庭在决定什么最符合儿童最大利益方面的作用。

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