The Role of Cognitive Development in Pediatric Medical Decision-Making

By Zinner, Susan | Global Virtue Ethics Review, January 1, 2004 | Go to article overview

The Role of Cognitive Development in Pediatric Medical Decision-Making


Zinner, Susan, Global Virtue Ethics Review


Abstract

This article examines the limitations of decision-making skills of children and adolescents in a medical context imposed by cognitive immaturity. The author considers the work of Piaget and other theorists who have addressed when children do and do not possess the requisite maturity to make their own decisions. Finally, the author proposes that providers individually assess the cognitive abilities of children in an attempt to ascertain when the child is able to make his or her own decision, regardless of chronological age.

Introduction

Western medicine, which has traditionally encouraged autonomous decision-making by patients, faces a special challenge when the patient is a minor. The fields of law, medicine and cognitive development may provide guidance in determining when a child is an appropriate decision-maker and when parental involvement is mandated.

The common law has traditionally rccognized the Rule of Sevens, which finds that "(1) under seven years of age there is no capacity; (2) between 7 and 14 years of age there is a rebuttable presumption of no capacity, and (3) between 14 and 21 there is a rebuttable presumption of capacity" (Cardwell v. Bechtol, 724 S.W.2d 739 (Tenn. 1987, cited in Rozovsky, 1990, p." 264). The law has therefore given its tacit approval of the concept of varying degrees of emotional and mental maturity to exercise judgment. Further, many states (such as Illinois) allow minors as young as 12 or 14 to receive treatment for outpatient mental health treatment, drug or alcohol abuse or for treatment of STDs without parental permission.

The American Academy of Pediatrics' (AAP) Committee on Bioethics developed a policy in 1995 in which they noted that "pediatricians should not necessarily treat children as rational, autonomous decision makers, but they should give serious consideration to each patient's developing capacities for participating in decision-making, including rationality and autonomy" (p. 315). The AAP Committee noted that medical staff should defer treatment to address patient concerns if the minor patient refuses to assent. Further, refusal to assent should "carry considerable weight when the proposed intervention is not essential to his or her welfare and/or can be deferred without substantial nsk"(p. 316). Finally, they note "coercion in diagnosis or treatment is a last resort" (Shield & Baum, cited in AAP Committee Report, 1995, p. 315).

Research in Cogitative Development

A classic study (1983) conducted by Lois Weithorn found that subjects aged 9, 14, 18 and 21 presented with complex scenarios in which they had to make medical treatment decisions for others all used similar reasoning processes. In three of the four scenarios, the nine-year-olds did not differ significantly from adults in the options they chose. Interestingly, the single divergence from the other three groups occurred when the nine-year-olds indicated a greater preference for hospitalisation than outpatient treatment, evidence of "the notion that "more treatment" is necessarily "better treatment"" (Weithorn, 1983). Further, despite evidence that the nine-years exhibited less understanding about the information provided in the scenarios, they did display "an impressive level of understanding" and used important factors when weighing the different treatment options (Weithorn, 1983). While Wcithorn notes that children and young adolescents may be inappropriately motivated by the desire to please others and may be easily influenced by parents, providers and significant others, "minors may be more capable than we expect" (Weithom, 1983).

It is this knowledge that a minor patient may be capable of the requisite critical thinking that has justified granting them limited autonomy in some cases. Autonomy, which many ethicists consider to be the leading value in medical decision-making in western-influenced cultures, is routinely accorded to the vast majority of adult patients in this country. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

The Role of Cognitive Development in Pediatric Medical Decision-Making
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.