The Mount Sinai journal of medicine, New York
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Case Reports
An exploration of the ethical, legal and developmental issues in the care of an adolescent patient.
Providers of health care to adolescent patients face numerous challenges. In addition to increased risk for many health problems, adolescent patients may bring complex ethical, legal and developmental questions to bear as they seek medical services. This article describes the case of one such adolescent patient and discusses some of the attendant issues faced by her physician. ⋯ Additionally, providers must be aware of financial barriers and they need to acquaint themselves with available services such as New York State's Family Planning Benefit Program. Attention to their patients' stages of cognitive and emotional development should inform providers' advice to adolescents, and an understanding of the importance that supportive adult relationships play during adolescence is essential to fostering healthy development. Open communication between adolescent patients and their parents or guardians should be encouraged, while maintaining the primary obligation of providing confidential care.
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This paper reviews the development of the concept of medical futility, particularly as it applies to pediatrics. It discusses the difference between technical considerations and value considerations in futility determinations, and then breaks down the concept of futility into four components - power, money, trust and hope.
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Parents often make medical decisions for their children. As pediatricians, we must be sure that the decisions are medically informed. At times, we may disagree with the decisions that parents make and must decide if they are acting in the best interest of their child. This article presents a case in which these issues arose regarding a child with trisomy 13.