A Time to Step In: Protecting Rights of Children in Health Care Decision Making
Introduction
As professionals, nurses have the responsibilities to have better understanding of the legal and moral rights of their patients to self determination. The nurse preserves, protects, and supports those interests by assessing the patient 's comprehension of both the information presented and the implications of the decisions (Bosek, 2005). Competence is defined as the condition of being adequately qualified or capable. Informed consent is based on the premise that the people giving consent are capable enough to weigh the potential risks and benefits of what they are consenting to (Bosek and Savage, 2007). Many aspects of children 's development are independent of age and hinge on exposure to opportunities and life experiences. Basing children 's competence only on an age based parameter is unethical because it is a violation of children 's rights. This paper is going to focus on children 's competence in making decision regarding their health from the perspective of children 's own human rights. Background Research Having the capacity to consent to treatment requires understanding the nature, benefits, risks, and side effects of the treatment. It also includes understanding the consequences of the decision to decline treatment. The principle of informed consent is well-established in nursing standards with respect to the common law. The Health Care Consent Act (HCCA) sets out explicit rules on when consent is required and who can give the consent when the client is incapable of doing so (College of Nurses of Ontario (CNO), 2009). According to the HCCA (1996), there is no minimum age for providing or refusing consent in Ontario. A person is capable if he or she understands the information given that is relevant to making a decision concerning the treatment, and can appreciate the anticipated consequences of both accepting or declining a treatment. (Keatings and Smith, 2009) A patient 's refusal to consent may not necessarily be evidence of his/her mental incompetence. Some patients may refuse treatment for reasons that are unusual, but when examined in more detail there may be logical reasons, where as some may agree to treatment without clear understanding of risks and benefits because they do not want to deny what their physician recommended for them. (Tunzi, 2001) The infoLAW, published by the Canadian Nurses Protective Society (CNPS), focused on the legal presumption that all adults have the capacity to consent to treatment. …show more content…
A nurse needs to explore a patient 's decision making capacity if there is a reasonable ground to believe that the patient does not understand the nature or the consequences of the decisions to be made (CNPS, 2009). When patients lack the competence to make a decision about treatment, substitute decision makers must be sought (Appelbaum, 2007). The Consent Practice Guideline laid out by the governing body for registered nurses in Ontario, asserted that, prior to obtaining consent, the nurse must use professional judgement to decide whether the patient is capable of giving informed consent. If nurses determine that the patient is incapable of making decisions, nurses have legal and moral responsibility to inform the patient about the role of a substitute decision-maker and the patient 's right to appeal to the Consent and Capacity Board for a review (CNO, 2006). The age-based parameter is not sufficient to determine the capacity of the child, as the capacity depends on each child 's intelligence, maturity, experience, and other factors. (Keatings and Smith, 2009) The United Nations Children’s Fund (UNICEF) asserts that children are not a homogenous group. They differ in socio-economic status, age and …show more content…
Article 3, best interests of the child, is an important principle that requires adults to give priority consideration to the impacts of their decisions on children. Article 24 is the primary article in the CRC that describes children 's health rights. This article describes the "right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health (CRC, 1990)." "The CRC situates children and youth as active participants in the world and calls upon us all to ensure their participation, provision and protection rights are protected because they matter now. Children’s rights are not hinged upon developmental markers or psychological achievements. Rather their rights to voice and choice, for example, must be granted because of children’s intrinsic value (Van Daalen-Smith, 2010,
Introduction
As professionals, nurses have the responsibilities to have better understanding of the legal and moral rights of their patients to self determination. The nurse preserves, protects, and supports those interests by assessing the patient 's comprehension of both the information presented and the implications of the decisions (Bosek, 2005). Competence is defined as the condition of being adequately qualified or capable. Informed consent is based on the premise that the people giving consent are capable enough to weigh the potential risks and benefits of what they are consenting to (Bosek and Savage, 2007). Many aspects of children 's development are independent of age and hinge on exposure to opportunities and life experiences. Basing children 's competence only on an age based parameter is unethical because it is a violation of children 's rights. This paper is going to focus on children 's competence in making decision regarding their health from the perspective of children 's own human rights. Background Research Having the capacity to consent to treatment requires understanding the nature, benefits, risks, and side effects of the treatment. It also includes understanding the consequences of the decision to decline treatment. The principle of informed consent is well-established in nursing standards with respect to the common law. The Health Care Consent Act (HCCA) sets out explicit rules on when consent is required and who can give the consent when the client is incapable of doing so (College of Nurses of Ontario (CNO), 2009). According to the HCCA (1996), there is no minimum age for providing or refusing consent in Ontario. A person is capable if he or she understands the information given that is relevant to making a decision concerning the treatment, and can appreciate the anticipated consequences of both accepting or declining a treatment. (Keatings and Smith, 2009) A patient 's refusal to consent may not necessarily be evidence of his/her mental incompetence. Some patients may refuse treatment for reasons that are unusual, but when examined in more detail there may be logical reasons, where as some may agree to treatment without clear understanding of risks and benefits because they do not want to deny what their physician recommended for them. (Tunzi, 2001) The infoLAW, published by the Canadian Nurses Protective Society (CNPS), focused on the legal presumption that all adults have the capacity to consent to treatment. …show more content…
A nurse needs to explore a patient 's decision making capacity if there is a reasonable ground to believe that the patient does not understand the nature or the consequences of the decisions to be made (CNPS, 2009). When patients lack the competence to make a decision about treatment, substitute decision makers must be sought (Appelbaum, 2007). The Consent Practice Guideline laid out by the governing body for registered nurses in Ontario, asserted that, prior to obtaining consent, the nurse must use professional judgement to decide whether the patient is capable of giving informed consent. If nurses determine that the patient is incapable of making decisions, nurses have legal and moral responsibility to inform the patient about the role of a substitute decision-maker and the patient 's right to appeal to the Consent and Capacity Board for a review (CNO, 2006). The age-based parameter is not sufficient to determine the capacity of the child, as the capacity depends on each child 's intelligence, maturity, experience, and other factors. (Keatings and Smith, 2009) The United Nations Children’s Fund (UNICEF) asserts that children are not a homogenous group. They differ in socio-economic status, age and …show more content…
Article 3, best interests of the child, is an important principle that requires adults to give priority consideration to the impacts of their decisions on children. Article 24 is the primary article in the CRC that describes children 's health rights. This article describes the "right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health (CRC, 1990)." "The CRC situates children and youth as active participants in the world and calls upon us all to ensure their participation, provision and protection rights are protected because they matter now. Children’s rights are not hinged upon developmental markers or psychological achievements. Rather their rights to voice and choice, for example, must be granted because of children’s intrinsic value (Van Daalen-Smith, 2010,