The moral landscape of pediatric oncology : an empirical study on best interests, parental authority and child participation in decision making

Abstract

Few medical specialties encounter so many ethical challenges as pediatrics does. It is a specialty that inherently has features that are morally charged. Pediatric ethics examines the broad issues of (1) the concept of the child__s best interest; (2) parental responsibility and authority in decision-making about the life and health of a child; (3) the emerging desire and capacity for self-determination of an older child, and (4) the professional obligation of a pediatrician to act in the best interests of the child. Much is written about these issues, but often the literature on these topics is either __academic__ and theoretical in nature, or casuistic. It remains difficult to utilize what is written in the reality of pediatric practice. In this thesis we reflect on the question how the concepts of best interests, parental authority and child participation can and should be translated and made operational in the everyday encounter between parents, physicians and children. We therefore combine theoretical conceptions of the best interest standard, child participation and parental authority with a close look on how these concepts actually function in pediatric practice, and how they are conceived by actors in the pediatric field.