Pediatric Dissent: An Underdeveloped and Challenging Concept
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.051 | 0.093 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.010 | 0.009 |
| Science and technology studies | 0.006 | 0.076 |
| Scholarly communication | 0.015 | 0.029 |
| Open science | 0.003 | 0.009 |
| Research integrity | 0.009 | 0.010 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".