Magazine article Policy & Practice
Making Medical Decisions for Foster Children
A function that distinguishes the job of many human service administrators is their responsibility for making decisions about medical treatment of children in agency custody. Because of the physical and mental traumas many of these children have faced, it is not unusual for the decisions to involve major surgery, orders not to resuscitate, or even withdrawal of life support.
Informed Consent: Information Needed by the Decision-Maker
When the agency makes decisions concerning the medical treatment of children in its care, it is performing a parental role and should exercise the same care as would a conscientious parent. This level of care is suggested by the law of informed consent, which requires the physician to provide the patient (or substitute decision-maker) with information about the medical risks and benefits of a proposed treatment and any available alternative treatments. This information enables patients to make an informed decision about what form of treatment is in their best interests.
To fulfill their responsibility to make an informed decision concerning children's best interests, administrators should obtain and use the following information:
* the child's medical condition,
* the form of treatment proposed and its anticipated benefits,
* risks associated with the treatment,
* any significant alternative forms of treatment,
* the name and telephone number of the treating physician in case further information is needed,
* the child's views about the treatment, if he or she is 14 years of age or older, and
* the child's foster parents' views about the treatment, particularly if the child has been in their care for an extended period.
Consideration of this information not only helps administrators make good decisions, but also helps avoid liability and political or media criticism in case of a bad outcome.
Decisions to Allow a Child's Death
The agency is sometimes asked to make a decision that will result in a child's death-either through withholding or withdrawing life-sustaining treatment, such as a ventilator, from a patient; or not resuscitating the patient if he or she stops breathing (known as a "DNR" or "no-code" order).
These are very difficult decisions, and the inclination for one charged with protecting the child's "best interests" often is to insist upon treatment. …