Do Not Resuscitate Orders: Parents' Decisions for their Child
Please answer these questions based on the reading lists:
Week 1: Tutorial Questions
Questions
TQ 1.1: In re K.I: What was the basis of the mother’s appeal? What errors does she claim the trial court made? Why does the court reject the mother’s arguments?
TQ 1.2: J.N. v. Superior Court: Why does the father argue that the trial court lacked the authority to issue a Do Not Resuscitate (DNR) order for his son? Why do the Agency, attorney for the child, and medical guardian argue that the trial court had the authority to issue the DNR order? Why does the appellate court reject their argument?
TQ 1.3: J.N. v. Superior Court: What is the role of a medical guardian? Why did the court appoint a medical guardian for the child?
TQ 1.4:Pustilnik & Henry: How is the adolescent brain different from the adult brain? How do these differences affect reasoning and decision-making by adolescents as compared to adults?
TQ 1.5: Unguru: The medical community agrees that, when treating older children, providers should obtain both the child’s assent and the parent’s consent to treatment. What is assent? How is it different from consent?
Week 1: Discussion Board Question 1 (At least 250 words)
Questions: *Each questions must be a minimum of 250 words
DQ 1.1: Although parents have a fundamental right to make decisions about their child’s medical treatment, when a parent has neglected the child, the court, not the parent, often makes medical treatment decisions. What role, if any, should a parent’s treatment preferences play in the court’s decisions about a neglected child’s medical treatment? Explain your position.
DQ 1.2: The U.S. Supreme Court considered the research on the adolescent brain when it barred the death penalty for crimes committed by adolescents under the age of 18 and also banned life sentences without parole for nonhomicidal crimes committed by minors. The same professional associations that argued to the U.S. Supreme Court that adolescents are not as mature as adults, and consequently should not be punished as adults for their criminal acts, have also argued that most minors are sufficiently mature to make certain medical treatment decisions without parental consent. Can these seemingly contradictory positions be reconciled?
The following is a list of the readings for Week 1 of this course:
A. Traditional Approach: Minors’ Incapacity to Consent
- Vukadinovich, Minors’ Rights to Consent to Treatment Vukadinovich, Minors’ Rights to Consent to Treatment - Alternative Formats - In re K.I. In re K.I. - Alternative Formats
- J.N. v. Superior Court J.N. v. Superior Court - Alternative Formats
B. Shared decision-making
- Pustilnik & Henry, Introduction: Adolescent Medical Decision Making and the Law of the Horse Pustilnik & Henry, Introduction: Adolescent Medical Decision Making and the Law of the Horse - Alternative Formats
- Unguru, Decisionmaking for Children with Life-Limiting Illnesses: A Clinical Approach Unguru, Decisionmaking for Children with Life-Limiting Illnesses: A Clinical Approach - Alternative Formats
- AAP, Informed Consent in Decision-Making in Pediatric Practice AAP, Informed Consent in Decision-Making in Pediatric Practice - Alternative Formats
Week 1
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Week 1
Tutorial Questions
TQ 1.1: Mother’s Appeal
In this case, the basis of the mother’s appeal was her contention of a verdict by a lower court regarding a Do Not Resuscitate (DNR) order issued on her two-year-old baby. According to the video transcript, the mother was duly convinced that the court had erred in applying the best interests of the child standard as opposed to the substituted judgment test. The latter would have allowed her to be the surrogate of the child. This would have constrained the pediatrician to seek legal authorization from her before undertaking any preferred treatment on the child. She had also argued that the court had abused its discretion in determining that the Do Not Resuscitate (DNR) order was in the best interest. As such, she felt that her opinion should have been respected in as important a matter as that concerning the life of her child.
The court rejected the mother’s arguments based on several factors. Firstly, the court had determined beyond any doubt that the mother had neglected her child. The court also argued that after balancing the burdens of continued life against the benefits and rewards of furthering life, the best interests would be served by issuing a DNR. This, in essence, meant that letting the child live would only cause prolonged unnecessary suffering.
TQ 1.2: J.N v. Superior Court
In this case, the father argued that the court had no right to issue a Do Not Resuscitate (DNR) owing to several reasons. According to the video transcript, he argued that the court had no authority to suspend his right to make medical decisions for his son until the son was declared dependent. He further argued that due process gave him the right to an evidentiary hearing before the court-appointed a medical guardian for his son. In addition to this, he contended that he should have been granted an evidentiary hearing before the issuance of the court orders. He also argued that the boy’s medication should not be halted since there was a chance of him hanging on and recovering miraculously.
The agency, the attorney for the child, and the medical guardian argued that the court had the authority to issue a DNR citing several reasons. Firstly, they argued that besides Cyrus being yet a child who could not make decisions, his brain was severely damaged. Besides this, they had suspicions that the parents could have been responsible for the grievous injuries to the boy. Secondly, they argued that Cyrus’s brain function continued to deteriorate and it was therefore in his best interests for the court to issue a DNR alongside the removal of the breathing tube. They argued that any further treatment of the boy was unnecessary since his existence had become a biological one.
The appellate court rejected the argument of the three entities basing their verdict on several arguments. It argued that it could not authorize the removal of the breathing tube if the boy could not breathe independently. The court also felt that a DNR order would withhold treatment. So it rejected the argument because it felt duty-bound to order the provision of necessary medical treatment and not withhold it.
TQ 1.3: Medical Guardian
A legal guardian is a person appointed by the court to stand in the place of unavailable parents or parents with a potential conflict of interest. A guardian can also be appointed in situations where the parents of an ailing child exhibit an inability to make decisions in the child’s best interests (Vukadinovich, 2004). In J.N’s case, a medical guardian was appointed because the above circumstances prevailed.
After Cyrus was taken to hospital following a massive head injury, he was intubated and then transported by an ambulance to a children’s hospital. After carrying out preliminary tests on the boy, the physicians decided that the injuries were highly suspicious for non-accidental trauma. They believed that the injuries were consistent with shaken baby syndrome. The injuries did not rhyme with the mother’s rather lame explanation that the boy had hit his head on the bathroom’s linoleum floor. To further fuel the physician’s speculation, the boy’s parents arrived at the children’s hospital two whole hours later and claimed to have lost their way. Later on, when detectives visited the child’s home for a reenactment of the accident, they found the apartment smelling strongly of a cleaning agent. They became suspicious and the child’s mother was arrested on charges of felony child abuse. These are the circumstances that precipitated the appointment of a medical guardian.
TQ 1.4: Adolescent and Adult Brain
Neurologists have managed to establish the differences that exist in the brains of adults and adolescents through neuro-imaging. One of the differences is that adolescents have got less developed “Executive Function.” This inference was reached after imaging studies showed that they have developing but incomplete prefrontal cortices (Pustilnik & Henry, 2012). Prefrontal cortices are the last part of the brain to develop fully. The other difference is that they process social cues differently from adults, which means that they not only reason less effectively but differently too.