Department of Philosophy

Philosophy professor co-authors article advising parents, clinicians on ethics of pediatric decision making

icon of a calendarAugust 30, 2023

Share this story

Philosophy professor co-authors article advising parents, clinicians on ethics of pediatric decision making
Pediatrics journal article co-authors
The article co-authors are pictured at the 2022 symposium “Best Interests and Beyond: Standards of Decision Making in Pediatrics” in St. Louis, Missouri.

What moral precepts ought to guide parents and clinicians in medical decision making for children? 

That fundamental question is the basis for a recent article published in the journal Pediatrics. Mark Navin, professor and chair in Oakland University’s Department of Philosophy, co-authored the article with 16 other leading pediatric bioethicists from diverse philosophical traditions and disciplinary perspectives.

The article resulted from a 2022 symposium the co-authors attended called “Best Interests and Beyond: Standards of Decision Making in Pediatrics.” They spent the three-day event building consensus on a topic known for being highly contentious – particularly amongst themselves.

“What's most notable about the article is that it is written by people who have been disagreeing with each other in the journals for 20-30 years,” said Navin. “Given that pediatricians and their patients need clear ethical guidance, the creation of a consensus document is a major accomplishment. It also shows the power of honest and open dialogue to help people find agreement where there may have first appeared to be little opportunity to do so.”

With the primary goals of accessibility, teachability, and feasibility for practicing clinicians, parents and legal guardians, the co-authors generated six consensus recommendations for making clinical decisions on behalf of child patients:

  • Parents should be presumed to have wide, but not unlimited, discretion to make health care decisions for their children.

  • Parents should protect and promote the health interests of their children while balancing practical constraints and/or other important obligations and interests.

  • A clinician’s primary responsibility is to protect and promote their pediatric patients’ health Interests. Clinicians’ recommendations should be informed by professional judgment and the best available evidence.

  • To respect children and promote their wellbeing, clinicians and parents should inform pediatric patients of salient information and invite their perspective to the degree that is developmentally appropriate.

  • In addition to fulfilling state-mandated reporting requirements, clinicians should seek state intervention when all less-restrictive alternatives have failed and a parental decision places the child at significant risk of serious imminent harm or fails to meet the child’s basic interests. 
  • Clinicians and parents should strive to collaborate in a shared decision-making process to promote the child’s interests.

Next steps will be to test the recommendations to determine how they apply to specific circumstances and pediatric populations, such as newborns, teenagers and wards of the state, and whether changes may be necessary.

Share this story