Case Study 22 : MINOR’S PROXY
Challenges
Three weeks before admission, a one-year-old girl experienced abdominal pain with vomiting, loose bowel movements (LBM), jaundice, and a 30% weight loss. Physicians diagnosed her with congenital heart disease (CHD), ventricular septal defect (VSD), tricuspid regurgitation (TR), and mitral regurgitation (MR) since birth. On the sixth hospital day, doctors found progression of pulmonary arterial hypertension (PAH) and respiratory distress, requiring intubation for three days. A day after removal of intubation, the father decided against allowing future reintubation.
The doctor told the parents that the child still held some hope for recovery. The mother expressed her desire to apply all possible procedures to save the baby, but the father stood firm in his decision against it.
Question
Whose decision should be followed? That is, who acts as the minor’s proxy?
Solutions
The minor’s exercise of legal decision-making passes over to the parents. Depending on cultural or legal traditions, in situations of disagreement between parents, either the father or the mother has to be followed; in other traditions, both parents possess equal weight, requiring a third party, such as the court, to decide. Moreover, the court can rule against one or both parents’ decision if it deems it best for the child, and can even appoint a legal guardian (the doctrine of Parens Patriae); in this scenario, the doctor and the hospital must carry out the court’s order.
At any rate, the legal venue should ideally be considered only a last resort. Doctors who maintain constant communication with the parents seek to explain all the stages of a child’s illness and management. This leads parents to feel updated and confident of the doctor’s care for their child. Parents generally trust that the doctor knows best, bringing them to judge the situation more objectively, and, most probably, arrive at the same decision for their child.
A certain familiarity with bioethical principles assists doctors in explaining to the parents certain principles to aid in their decision-making (e.g., in this case, principles related to withdrawing or withholding life support). Only after having carefully studied all the factors involved can the parents arrive at a truly free and informed consent as to how to manage their child.
