Pediatric Dissent: An Underdeveloped and Challenging Concept
Notice bibliographique
Résumé
Introduction. There have been many news articles reporting on court cases where a minor and/or their parent(s) have refused lifesaving treatments. These make for interesting debates, but not all paediatric refusals to care end up before the courts. What should healthcare providers do when a minor refuses to participate in a care plan the adults believe to be in the minor’s best interest? The objective of this literature review is to identify the current discussions surrounding paediatric dissent in research and clinical settings as well as the strengths and limitations of the most prominent perspectives on dissent. Methods. For this qualitative study, the MEDLINE® ALL (1946-March 22, 2022) database was used. One thousand two hundred and twelve articles were found in the initial search, ninety-five of which were retained after screening. Articles were included from research and clinical settings as well as case studies. Only 19 articles discussed dissent in detail. An additional search was done examining the existing legislative and regulatory frameworks across Canada regarding a minor’s ability to consent to treatment. Results. Three main categories – research, clinical, and legislative and regulatory frameworks – were subdivided into three subcategories: Current Views on Dissent; A Minor’s Capacity and its Complexity; and Lack of Guidelines and Clarity Regarding a Minor’s Capacity to Dissent. First and foremost, this review revealed a significant gap in knowledge surrounding paediatric dissent. In research settings, it is well established that assent should be sought from minors. In these settings, many authors agree that dissent should be respected, but disagreement exists regarding what dissent may look like, or when a child truly is capable of dissenting to something they may not understand. In clinical settings, the debate surrounding dissent is intertwined with the concept of assent. Some authors argue that obtaining assent is synonymous to seeking the minor’s preferences. Others argue that if assent is to be sought, then dissent should be respected equally. Most of the literature in this review (92% of manuscripts reviewed) spoke to minors’ decision-making capacity regarding treatment. In both the research and clinical settings, the difficulty of assessing a minor’s capacity was noted. Authors argue that minors who are capable of assent can also dissent, although others say that minors do not have sufficient life experience or maturity to make life-altering treatment decisions. Finally, many authors have noted the absence of guidelines and regulations regarding a minor’s dissent to treatment or to participate in research. A review of the Canadian legal and regulatory landscape regarding minor’s ability to consent to treatment revealed another significant gap in knowledge related to paediatric dissent. Conclusion. The limitations of grounding dissent on similar principles used in discussions on assent and capacity are presented, and other potential avenues in interdisciplinary studies of childhood ethics are considered in place of pediatric dissent
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,051 | 0,093 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,010 | 0,009 |
| Études des sciences et des technologies | 0,006 | 0,076 |
| Communication savante | 0,015 | 0,029 |
| Science ouverte | 0,003 | 0,009 |
| Intégrité de la recherche | 0,009 | 0,010 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».