Incompetent Children Research Articles

Follow-up in the field of reproductive medicine: an ethical exploration

Research questionWhat ethical implications, issues and concerns play a role in conducting follow-up studies of children born after assisted reproductive technologies (ART)? DesignLiterature study and relevant experiences of academic medical centres in Brussels, Belgium, and Maastricht, the Netherlands were used to identify and analyse the most pertinent ethical implications, issues and concerns. ResultsAccording to recommendations from the European Society of Human Reproduction and Embryology, follow-up (ideally long term) of children conceived through medically assisted reproduction (MAR) should be an integral part of introducing new ART. With potentially risky new ART on the horizon, these recommendations need to be taken more seriously. Apart from practical barriers, such as funding, challenges for follow-up include securing active involvement of families of children conceived through MAR, starting with parents of young children, and ideally involving consenting adolescents and adults during a large part of their lives, possibly even into the next generation. ConclusionsFrom an ethical viewpoint, the most pertinent issues include the proportionality of the inevitable burdens and risks for families of children conceived through MAR, and the implications of the principle of respect for autonomy. The proportionality requirement is most critical when it concerns incompetent children, who should not be included in research with more than minimal burdens and risks if there is no reasonable expectation of benefit for themselves. With respect for autonomy, we argue that, when seeking voluntary consent for participating in follow-up studies that meet the condition of proportionality, professionals may encourage members of families of children conceived through MAR to partake in follow-up research.

Decision-making through the lens of a pediatric cancer case

It is crucial to obtain a competent individual’s informed consent in any medical process, including cancer treatments. However, when it comes to incompetent children, it seems to be favourable, but not necessary, to obtain their assent in medical practice.1 This paper considers Christine Harrison’s example of Samantha, an eleven-year-old girl that was treated for osteosarcoma in her left arm. Samantha had previously been treated by amputation and a course of chemotherapy. This cancer later metastasized to her lungs, decreasing her chances of remission with aggressive treatment to 20%. Although she wanted to refuse treatment, she was deemed incompetent to make decisions about her cancer care, and her parents adamantly wanted her to continue treatment.7 This paper considers physicians’ moral obligations in pediatric cancer cases such as Samantha’s. I will define assent, the principles of autonomy, beneficence, and competence as it pertains to children. I consider arguments of two opposing views–a child’s rights view that argues in favour of Samantha’s decision, and a paternalistic view that opposes her. After reviewing the bioethical literature on the risks and benefits of children’s decision making in health care, I argue that Samantha’s wishes to stop treatment ought to be respected.Throughout the paper, I will use the bioethical principles of respect for autonomy and beneficence to defend my position. Finally, I address potential objections my position may face and conclude.

Economic Growth With Locked-In Fertility: Under- and Over-Investment in Education

This research theoretically analyzes the role of irreversible fertility decisions in economic growth in the presence of idiosyncratic ability shocks after childbirth. It argues that the irreversibility constraint delays the growth process by distorting the resource allocation between the quantity and quality of children. In underdeveloped stages, where family size is locked into large levels, education investment places a heavy financial burden on households. The impossibility of ex post fertility adjustment then deprives some competent children of learning opportunities. In more developed stages, by contrast, family size locked into smaller levels facilitates education investment even in some incompetent children. A redistributive policy to enhance aggregate human capital and the growth performance is proposed for each stage.

‘Don’t be Such a Baby!’ Competence and Age as Intersectional Co-markers on Children’s Gender

The aim of this paper is to show how norms about age intersect with gender and thus create social positions about incompetent and competent children. The paper also analyzes the relationship between gender, incompetence, and notions of ‘the baby.’ The theoretical framework uses concepts taken from gender theory (Butler, Gender trouble. Feminism and the subversion of identity, 1990, Bodies that matter. On the discursive limits of ‘sex,’ 1993; Thuren, Kvinnovetenskaplig Tidskrift 3–4:69–85, 1996) and the data are analyzed from an intersectional perspective with regard to gender and age. The material is taken from ethnographic observations conducted over the course of two years at two Swedish preschools. The result shows that norms about age and competence in early childhood are stressed in different ways at preschools. Norms about age often manifest in relation to incompetence. In the study, older preschool children understood the meaning of ‘incompetence’ as lacking control and acting in ways that could be disciplined in various ways depending on the child’s gender. Age is also a marker of status among children and all the children we observed wanted to be identified as ‘big.’ We conclude that when age is emphasized, gender norms are also stressed. The notion of ‘being a baby’ constitutes a powerful way to police the border between those who are and are not gendered subjects. This study highlights the importance that age holds even for young children as they negotiate and naturalize the notions of two different genders. It also shows how important it is to be clearly gendered in order to be understood and be considered normal.

Legal Aspects of End-of-Life Care

Critical care nurses are essential members of the health care team and often assist patients and patients' families who are facing end-of-life concerns. In that role, a nurse needs an understanding of many important factors, including legal implications associated with the end of life. Since the 1970s, courts have decided several cases that have established legal principles in end-of-life care. Courts have found that competent adults have the right to refuse or discontinue medical interventions. For incompetent adults and children, decisions are made by a surrogate. In the absence of an advance directive or documentation of goals of care, the surrogate, in collaboration with the medical team, determines a plan of care, including decisions about end-of-life care. When issues of medical futility occur, attempts to work with patients and their families should be undertaken, but if the dispute cannot be resolved, a transfer in care may be the only option.

Assent for children's participation in research is incoherent and wrong

When children are considered for participation in research, British and international guidelines suggest that they should provide assent in addition to their parents' consent. However, examination of these guidelines shows...

Would an english court find non-therapeutic circumcision of incompetent children lawful?

BackgroundVarious legal aspects of non-therapeutic circumcision have been considered by the courts in England and Wales. For example, the necessity to obtain dual parental consent for the surgery; and whether...

750 Assent in Research for Children is Problematic

Introduction: Authoritative research guidelines from Europe, USA and Australia suggest that incompetent children ought to assent, when unable to consent. What assent means here is both unclear and morally problematic. I argue that if parents consent (that is choose) the role of the child's assent is unclear.Problems with assent: Firstly, a practical problem arises if parent and child give incompatible responses to consent and assent. The research will either continue or be withheld. If the child can be over-ruled, then assent seems meaningless. Alternatively, if the parents are overruled then this is not consent. But if consent is the authority to proceed, then assent has no role. Secondly, there are other conceptual problems with assent itself. For example, it is emphasised in research, but is largely ignored in medical treatment. Why? In addition, in many descriptions of assent, what is described is lack of dissent. Thirdly, as well as incoherence, the requirement for assent may cause other moral problems. If parents do choose for their children (and ignore the child's views) or if a child's assent contains a veto over the parents' consent, then we may be introducing tensions into the decisionmaking within a family.Some children can consent. Parents of incompetent children must consent (or not) usually consulting with their child. Children should have an input into their parents' decisions but as one component in the decision, not an independent choice.Conclusions: The notion of assent is both flawed and morally problematic. Children's research regulations should be reformed.This Work was Supported by the Wellcome Trust [WT087470MF].

Medical ethics for children: applying the four principles to paediatrics

I will argue that there are difficulties with the application of the four principles approach to incompetent children. The most important principle – respect for autonomy – is not directly...

Attitudes regarding carrier testing in incompetent children: a survey of European clinical geneticists

The aim of this study is to gather information from European clinical geneticists about their practices and attitudes with regard to carrier testing in incompetent children. European clinical institutes where genetic counseling is offered to patients have been contacted. One hundred and seventy-seven of the 287 eligible respondents, corresponding to a response rate of 63%, completed the questionnaire. For all autosomal recessive and X-linked disorders studied, the majority of the respondents were very unwilling or unwilling to provide a carrier test to a 6-year-old asymptomatic child on parental request (range 73-91%). The results of the Wilcoxon-Mann-Whitney U test indicated that for almost all disorders, respondents from Eastern and Southern European countries are more willing to provide a carrier test to a 6-year-old asymptomatic child than respondents from Western and Northern European countries. The Spearman's rank correlation coefficients showed that when a clinical geneticist was unwilling to perform such a test, he/she mostly disagreed that parental uncertainty and anxiety was a good reason to perform a carrier test, he/she mostly disagreed that parents should have the right to decide about such a test, he/she mostly agreed that future autonomy and the confidentiality of genetic information is violated if this test is performed. Overall, the survey showed an adherence to existing recommendations and guidelines regarding carrier testing in incompetent minors. However, for every condition studied, a group of clinical geneticists was willing or very willing to provide a carrier test to a 6-year-old child on parental request.

The Ashley Treatment: Best Interests, Convenience, and Parental Decision-Making

story of Ashley, a nine-year-old from Seattle, has caused a good deal of controversy since it appeared in Los Angeles Times January 3, 2007. (1) was born with a condition called static encephalopathy, a severe brain impairment that leaves her unable walk, talk, eat, sit up, or roll over. According her doctors, has reached, and will remain at, developmental level of a three-month-old. (2) In 2004, Ashley's parents and doctors at Seattle's Children's Hospital devised what they called Ashley Treatment, which included high-dose estrogen therapy stunt Ashley's growth, removal of her uterus via hysterectomy prevent menstrual discomfort, and removal of her breast buds limit growth of her breasts. Ashley's parents argue that Treatment was intended to improve daughter's quality of life and not convenience her caregivers. (3) They also decided share thoughts and experience ... help families who might bring similar benefits their bedridden 'Pillow Angels,' which means that this treatment has public policy implications. In case of incompetent children like Ashley, parents are custodians of child's interests and are required make decisions that protect or promote those interests. Doctors should also offer treatments that are in Ashley's best interests. It would be wrong offer a treatment that was against interests of child but in parents' (or others') interests. central questions in medical ethics in relation this case are: Were these treatments in Ashley's best interests? Do they treat her as a person with dignity and respect, and were they likely make her life go better? Ashley's parents argue that they sought treatment in order alleviate Ashley's discomfort and boredom. Their contention that stunting Ashley's growth was done for sake of improving our daughter's quality of life and not convenience her caregivers is controversial. According her parents, keeping small--at around seventy-five pounds and four feet, five inches tall--means that can be moved considerably more often, held in their arms, be taken on trips more frequently, more exposure activities and social gatherings, and continue fit in and be bathed in a standard size bathtub. All this serves Ashley's health and well-being because, so parents argue, the increase in Ashley's movement results in better blood circulation, GI functioning (including digestion, passing gas), stretching, and motion of her joints, which means that will be less prone infections. Undoubtedly, parents are right that will benefit in manner they have proposed if they can do all these things for her. claim about value of small size in a particular social circumstance is certainly not unique. Dwarves have given same argument as a justification for preferring have short children. They have argued that parenting dwarves is desirable for them because of their own size and because they have made modifications their homes and their surroundings take into account their short stature. (4) As a general point, it is entirely conceivable that in some natural, social, or psychological circumstances, having a normal body may be a disadvantage. In H.G. Wells' short story The Country of Blind, Nunez, a mountaineer in Andes, falls and comes upon Country of Blind. Nunez has normal vision, but in this society of blind people, he is disadvantaged, and he eventually consents have his eyes removed. Similarly, in a world of loud noise, being able hear could be a disadvantage. In case of apotemnophilia--a body dysmorphic disorder in which patient feels incomplete possessing all tour limbs--doctors justify amputation by reasoning that patient's psychology demands it. In Ashley's case, having a normal-sized body could be a disadvantage. …

Dignity in dying should include the legalization of non-voluntary euthanasia

often be exacerbated by the absence of any means of communicating their confusion and despair to those responsible for their care. The fact that the best interest of these patients has figured so little in debates about euthanasia is understandable. Many reflective practitioners who support the legalization of VAE have reservations about taking the lives of those who have not executed relevant advance directives and who are defenceless to protect themselves through the exercise of their autonomy. Equally, the Nazi murder of incompetent children and adults continues to cast a dark shadow over the legitimacy of non-voluntary active euthanasia (NVAE). In my view, however, this emphasis on autonomy should be reconsidered in debates about euthanasia. The interests and needs of severely incompetent humans who may also be in the grip of intolerable suffering are just as important as those patients who are competent to control the circumstances of their death and wish to do so. Therefore, I believe that NVAE should also be legalized. I have four reasons for this belief.

Compromised emotional competence: seeds of violence sown early?

The authors expected less secure preschoolers to be less emotionally competent when interacting with peers at age 3 and that these emotionally incompetent children, especially those who showed much unregulated anger, would be less socially competent in kindergarten. These directional hypotheses were examined in a sample of 91 preschoolers, and all were corroborated.

Czego nauczyło nas Baby Doe?

The paper reconstructs a famous ethical debate on the Baby Doe case. The consequence of the fact that contemporary medicine can not and probably should not treat all severely handicapped children is twofold: we have to establish who is entitled to decide on the ways of treatment in the case of incompetent children (physicians, parents or ethical committees); and what are the criteria of fair judgment. The second part of the paper is an overview of Polish legal regulations establishing the proper kinds of treatment in the case of terminally ill patients. The author concludes with some remarks on the place of ethical debate in political life of contemporary Poland.

Donation without consent? Legal developments in bone marrow transplantation.

Donation without consent? Legal developments in bone marrow transplantation.

Cognitive-behavioral group therapy for socially incompetent children: Short-term and maintenance effects with a clinical sample

Presented a multisite treatment-outcome study designed it0 investigate the efficacy of a cognitive-behavioral group therapy for clinically referred, socially incompetent children. The treatment was aimed at both externalizing and internalizing 8- to 12-year-old children. Seventy-two children referred to outpatient mental health centers for peer relationship problems received 20 weekly sessions of group treatment. Each treatment group consisted of 6 children. Thirty children acted as a waiting list control group. Treatment outcome was assessed by teacher and parent reports on social behavior, sociometrics, and self-reported social anxiety and negative self-evaluation. The results reveal that, after treatment, children exhibited more appropriate social behavior. An increase in peer acceptance and an increase in the number of friendships were found. These effects were sustained at 4- to 5-month follow-up assessments. Post hoc multivariate analyses of variance revealed no differential treatment effects for se...

Early Family Experience, Social Problem Solving Patterns, and Children's Social Competence

PETTIT, GREGORY S.; DODGE, KENNETH A.; and BROWN, MELISSA M. Early Family Experience, Social Problem Solving Patterns, and Children's Social Competence. CHILD DEVELOPMENT, 1988, 59, 107-120. The relations among early social and familial experience, social problem solving skill, and social competence in the classroom were examined in a sample of 46 preschool (4and 5-yearold) children from economically distressed backgrounds. The hypothesis was tested that (a) early family experiences would be related to classroom social competence, and (b) that this relation would be mediated by the child's social problem solving patterns. Early experience was assessed during a semistructured home-visit interview with each child's mother. Measures derived from this interview included the child's level of exposure to deviant aggressive models, maternal values and expectations for the child, harshness of discipline toward the child, use of preventive teaching with the child, and the child's degree of early experience with peers. The child's classroom competence was assessed by sociometric nominations and teacher ratings of aggressiveness and social skill. Responses to hypothetical social problems were used to generate measures of the child's social problem solving patterns. Several dimensions of family experience were found to be predictive of both classroom social competence and social problem solving. Stepwise regression analyses revealed that some kinds of early experience (e.g., early experience with peers) appeared to have a direct impact on peer outcomes, whereas for other experiences (e.g., exposure to deviant maternal values and expectations), the relation to social competence with peers was mediated by the child's social problem solving skills and patterns. The need to consider family relationship factors when designing preventive intervention programs for socially incompetent children was stressed.

Physical Competence and the Development of Children's Peer Relations

One factor that appears to have significant influence on peer relations, especially for boys, is physical competence. Children gain peer acceptance by excelling at something valued by other children, and there is much evidence that athletic skills are valued by other children. Literature on physical competence and peer relations illustrates that children with competent motor skills appear to be popular not only in formally organized competitive sport settings but also in informal “pick up” games. The inferior status of low ability children is clearly evident when they attempt to gain entry into playground games. It is concluded that physically competent children acquire more status and enjoy greater social success than do physically inept children. In conclusion, the article suggests that physical education may be used as an intervention strategy to enhance the peer status of physically incompetent children by improving their motor skills.

Developmental Differences in Evaluative Reactions to Physically and Mentally Handicapped Children

Children and adolescents in 3rd–4th, 7th–8th, and 11th—12th grades were given a description of a same-sex child who was either nonhandicapped, physically handicapped, or mentally retarded, and who was academically and socially competent or incompetent. Developmental differences in reactions to handicapped children were assessed through measures of attributions for performance, trait perceptions, and expectations for future success. Attributional measures revealed little except an increase in internal attributions with age, especially among girls. While young children stigmatized both physically handicapped and mentally retarded incompetent children under some circumstances, older children leaned toward favoring the incompetent and handicapped children, though high school students also tended to derogate a competent retarded child. Young boys were pessimistic about the future of the physically handicapped child, and young girls about the future of the retarded child; 7th—8th graders did not differentiate a...

Childhood competence and behavior problems.

This study examined the relationship between objective measures of childhood competence and behavior problems. Daily class work measured the academic competence of 474 children, Grades 2-6, and peer ratings measured social competence. Median splits formed four groups, with competent children highest and incompetent children lowest on the relatively independent dimensions of academic and social competence. Competent children excelled on attitudinal measures of a competent lifestyle, and on the Harter Competence (HC) scales. Teacher ratings on the Quay-Peterson Behavior Problem Checklist (BPC) attributed fewest problems to competent children. Conversely, incompetent children achieved the lowest HC and the highest BPC scores. Children high on social competence and low on academic competence were distinguished by BPC conduct problems and nervousness. Peer nominations of depression on the Lefkowitz and Tesiny scale characterized all children low on social competence.