II. Indications: Guardian consent not needed
- Emergency with threat to life or limb (EMTALA)
- Right to treatment (state protected)
- Child Abuse
- Pregnancy
- Sexually Transmitted Disease
- Substance Abuse
- Outpatient mental health (in some states)
- Emancipated minor (state defined)
- Married
- Member of the Armed Services (e.g. Navy, Marines, Air Force, Army, Coast Guard)
- Living independently and self-supporting (reportable case)
III. Approach: Parent and Surrogate Decision Making for Children
- Contrast surrogate decision making in young children with that of older children and adults
- In adults, substituted judgment is based on knowing a patient's opinions and values
- The surrogate acts on what they believe the adult patient would want
- Younger children do not typically have the ability to understand their medical options and make decisions
- Instead, parents and surrogates practice what they interpret as best interests of the child
- "Best interest" is often difficult to determine, and may reasonably vary from one surrogate to another
- Nonmaleficence ("do no harm") may be a more manageable way to judge surrogate decision making
- The clinician should consider whether surrogate decision making risks significant child harm
- Does the decision making risk life or health loss or deprive basic needs?
- When surrogate decision making appears to break Nonmaleficence and put the child at significant risk
- Consider whether the surrogate is transiently incapacitated (e.g. Intoxication)
- Attempt to negotiate with the parent or surrogate if the have maintained capacity
- Involve law enforcement and hospital security if a compromise that is safe for the child cannot be made
IV. Approach: Resuscitation
-
Advanced Directives (including DNR)
- Prevalence of life limiting illness in U.S. children: 500,000
- Less than 3% of U.S. children with life limiting illness have an Advanced Directive
- DNR Orders
- Confirm certified paperwork or medical alert bracelet before following DNR order
- Perform full Resuscitation in acutely life threatening cases where the DNR order can not be verified
- The legal guardian may revoke a DNR order at any time
V. References
- Seeyave, Sherman and Ward (2020) Crit Dec Emerg Med 34(1): 19-25
- Bukata (2013) Emergency Pediatrics, EM Bootcamp, CEME
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Related Studies
| Definition (MSH) | Informed consent given by a parent on behalf of a minor or otherwise incompetent child. |
| Concepts | Idea or Concept (T078) |
| MSH | D033282 |
| English | Consent, Parental, Parental Consent, parental consent, consent parental |
| Swedish | Föräldrasamtycke |
| Czech | souhlas rodiče |
| Finnish | Vanhempien suostumus |
| Russian | INFORMIROVANNOE SOGLASIE RODITELEI, ИНФОРМИРОВАННОЕ СОГЛАСИЕ РОДИТЕЛЕЙ |
| French | Consentement d'un parent, Consentement parental |
| Polish | Zgoda rodziców |
| Norwegian | Foreldres samtykke, Foreldresamtykke, Foresattes samtykke |
| Portuguese | Consentimento do Responsável, Consentimento Materno, Consentimento Paterno, Consentimento dos Pais |
| German | Einwilligung der Eltern, Einwilligung, elterliche, Elterliche Einwilligung, Elterliche Zustimmung |
| Italian | Consenso del genitore |
| Dutch | Toestemming van ouder |
| Spanish | Consentimiento Paterno |
Ontology: Informed Consent By Minors (C2936241)
| Definition (MSH) | Voluntary authorization by a person not of usual legal age for diagnostic or investigative procedures, or for medical and surgical treatment. (from English A, Shaw FE, McCauley MM, Fishbein DB Pediatrics 121:Suppl Jan 2008 pp S85-7). |
| Concepts | Idea or Concept (T078) |
| MSH | D057828 |
| English | Informed Consent By Minors |
| French | Consentement éclairé chez les mineurs, Consentement éclairé des mineurs |
| German | Einverstaendniserklaerung von Minderjaehrigen, Einverständniserklärung von Minderjährigen |
| Czech | informovaný souhlas u nezletilých |
| Italian | Consenso informato di minori, Consenso informato di minore |
| Spanish | Consentimiento Informado en Menores |
| Russian | INFORMIROVANNOE SOGLASIE NESOVERSHENNOLETNIMI, INFORMIROVANNOE SOGLASIE NA LECHENIE OT NESOVERSHENNOLETNIKH, ИНФОРМИРОВАННОЕ СОГЛАСИЕ НЕСОВЕРШЕННОЛЕТНИМИ, ИНФОРМИРОВАННОЕ СОГЛАСИЕ НА ЛЕЧЕНИЕ ОТ НЕСОВЕРШЕННОЛЕТНИХ |
| Portuguese | Consentimento Informado por Menores |
| Polish | Zgoda świadoma małoletniego |
| Norwegian | Informert samtykke fra mindreårige, Mindreåriges samtykke, Mindreåriges informerte samtykke |
