Though we had to rush through Cases 4 and 5, the discussion in class was very tough, as these two cases were definitely the hardest for me of the 5.
Can parents be more clinical about their decisions concerning their own children's life?
I believe that the parent goes through multiple stages of teeter-tottering between being more medically minded to more emotionally minded when their child is going through life-altering treatments. First, they are solely emotional: they have little idea what is going on medically and keep that clinical decision making in the hands of the doctors. They deal with the emotional consequences and do whatever they can to save their child. Then, when things get worse, treatments get more risky, the parents begin to weigh in more of what the actual procedures are doing, and want to see how they can alleviate those treatments to make sure their child is in the best care possible. Then in terminal situations, the hardest cases, parents must use both clinical outlooks on the situation and block the emotional side, but this is the hardest stage to do. The pain and uncertainty of the child's wellbeing takes over, and many times parents can go into overdrive making sure that their child survives. In our case, case 5, the parents have employed their idea of the clinical side a little too late, and figure that it's okay to pull the plug after the physicians have said that that decision was warranted. I hate to put this much pressure on the physicians, but when more professional medial experience says to do something, that should be the method followed, and parent autonomy should be halted. What the parents in case 5 need to understand is that they have already driven the situation so far into a painful situation for the child that they cannot turn back. They need to do everything in their power to save their child.
In the twitter discussions, parent autonomy was a popular topic, seeming to range from where on the spectrum the parents lose the ability to make decisions concerning the time of death of their child. I would question whether or not along that scale does the parent lose control of recognizing the clinical thoughts concerning their child and their decision on the overall well-being of the child: if the child is already in so much pain, why stop treatment now?
But that brings us back to the idea of when does the hospital stop paying for treatment. I would argue in that case when the doctors decide that further treatment would do nothing to further alleviate the pain of the patient, treatment should be halted.
This is obviously another case where you could go around in circles with spectrums of opinions.
It is very true for a lot of these topics that we can go around and around on what is the best way to make decisions. While we are prone to focus on autonomous decision-making, very few individuals have all the information needed to make a fully informed decision. This is further complicated in the cases of the NICU where the patient is never the decision-maker and conflicts of interest come in to play. You are doing a good job thinking about these issues.
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