Parent–Child Conflict

Based on their experience, many physicians recognize that even very small children know when they are very sick. As discussed in Chapter 4, they are often far more aware of death than adults may realize.

Medical and nursing care of seriously ill children includes helping them to achieve a developmentally appropriate understanding of their illness and making sure that they know what to expect from tests and treatments. Their views should be taken seriously, but these views may or may not be the deciding factor in therapeutic decisionmaking.15

Preadolescent children are rarely, if ever, asked if they want the medical care their physician and parents decide is best for them. No one asks a 6-year-old if he wants an injection. He is told that he is going to get one and what it will feel like. (A child can still be offered choices such as which arm to use and can still be advised on what he or she can do to make it hurt less.)

For adolescents, the picture is more complicated. Under English common law, a minor was emancipated if he (not she) was a young man who was not subject to parental control or regulation. In all aspects of his life, he was considered to be a legal adult and could buy and sell property, sign contracts, get married, or do anything else adults could do.16 The American legal system adopted the concept. In twenty-first century America, an emancipated minor is one who is married, is in the military (a much less frequent occurrence than it was when the age of majority was 21 instead of 18), or is self-supporting and living away from home. If a minor’s marriage is dissolved, he or she remains emancipated. In addition to these categories of emancipated minors, many states have enacted statutes providing other contexts in which a minor (with or without a court order) is emancipated and, thus, whose parents have no further legal responsibilities for him or her.

15  

In distinguishing legal consent to treatment from a child’s assent, the American Academy of Pediatrics (1995a, online, no page number) described the process of securing assent (consistent with the child’s stage of development) as including at least these elements: “(1) helping the patient achieve a developmentally appropriate awareness of the nature of his or her condition; (2) telling the patient what he or she can expect with tests and treatment(s); (3) making a clinical assessment of the patient’s understanding of the situation and the factors influencing how he or she is responding (including whether there is inappropriate pressure to accept testing or therapy); and (4) soliciting an expression of the patient’s willingness to accept the proposed care.” The AAP noted with respect to the last point that if, in fact, “the patient will have to receive medical care despite his or her objection, the patient should be told that fact and should not be deceived.”

16  

At the time, women of any age could not own property or sign contracts, so there was no reason to consider emancipation for girls.



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