Adjusting Childrens Rights In The Clinical Practice Of Pediatrics

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Stavroula Papadakou – Lagogianni M.D.
Director of the Pediatric Department of Asklipio General Hospital of Voula

It has been for many years now that the Universal community has been dealing with the rights of children that are appealing to healthcare units. Plots have been designed and efforts are supported to establish their practical enforcement.


   Acknowledging that children have rights and that they are not just pathetic recipients of care and protection from adults, constitutes the main idea in the philosophy of securing the rights of our young patients.
   Instead of being casual observers, children can and should, under certain circumstances, preserve their rights and participate in deciding which diagnostic or therapeutic interventions should be chosen for their own wellbeing.
   Such a suggestion would definitely have an impact on the traditional relationship between doctors and children but also between doctors, parents and children. Ethical concerns will definitely derive, especially after exercising the paternalistic model of doctor – patient relationship.
   In most of the countries around the world, including Greece, the voice of Children is not being heard. Society is not only resisting to apply this idea, but it can be said that adults are even hostile to the perspective of children taking part in decisions concerning their health.
   For an essential change to happen pediatricians, nursing staff and other health professionals should all work together to enforce new practical codes and ideas for a better communication between the two sides.
   After all this is said pediatricians have a new role apart from their traditional therapeutic one, maintaining children’s rights.
   Pediatrics is the branch of medicine that deals with health, prevention and therapy of children, a special category of patients that is represented by others.
   Claiming the rights of these “special” patients is therefore a hard task from its nature.
   Articles 5, 12, and 16 of Children’s Rights are those that have a direct affect in the everyday practice of pediatrics and the relations between doctors, nursing staff and other health professionals.
   Children’s Rights don’t give Children the right to act all by their selves, on the contrary they recognize their right to express their point of view in decision making and they value their consent to the diagnostic and therapeutic medical interventions after taking under consideration their psycho-emotional maturity. This means that depending on the age and especially their developing skills and their level of understanding, we can give them the responsibility to make decisions and give their consent to examinations and therapy.
   In most countries, including Greece, the age for consent of medical therapy is stated by law to be 18 years old and even though we have to comply with the law, the philosophy of Children’s Rights demands from pediatrician’s to begin recognizing the right of children to take part in decisions concerning their health.
   Therefore we have to guide parents through recognizing how important the role of their children is as far as their health is concerned and also help them manage the conflict between their rights and their children’s rights.
   It is very important to keep in mind that parent’s rights and their responsibilities exist so that their children’s rights can be maintained and protected. From this it can be understood that the two cannot be in conflict. When a child is mature enough to stand up for their self, then respectively the parent’s rights should subside.
   In the everyday practice of pediatrics in a hospital, private practice and social setting the rights of Children should be enforced as they are stated under articles 15,12 and 16 of the legislature of Children’s Rights. In detail those are the following :

Article 15: The right to respect the Childs developing skills
In detail:
• Our obligation to determine the level of understanding for every suggested therapeutic intervention, their opinion and their ability to cooperate with us in the decision making for therapy.
• The requirement of both parents and children to work together for the best, depending on each situation, therapy of the child.
• The problems that arise when the child refuses to give their consent to therapy.

Article 12: The right of the child to be heard and to be taken into serious consideration.
In detail :
• Encourage the right of all children who are capable to express their opinion.
• The right of all children to comment upon matters that concern them with no hesitations
• Our obligation to take under consideration their opinion.
• The importance we have to give to children’s opinion in correlation with their psycho-emotional maturity

Article 16: The right to preserve the personal life of the child and the classified medical acts.
In detail:
• To respect the medical confidentiality for teenagers who seek medical help
• The need for development and promotion of clear instructions to licensed health professionals for classified advice.
• The need for clarification of the laws that concern juveniles so that we can develop strategies respectively.

To apply the rights of children we have to start by promoting the active involvement of children in their health care. This participation would bring only positive effects, such as:
• Gain of self respect for the child
• Stress reduction which would lead to a better cooperation towards therapy
• Gain of self confidence since the children will not be scared they would endure something they don’t know and don’t understand
• Gain of responsibility for their own health

We should develop strategies towards this direction. The guidelines exist but we have to find innovative ways to inform parents about them. Furthermore children should also be informed about their condition in ways that are appropriate for their age group and psycho-emotional development. This is a difficult task and it must be done by an individual that the child knows and trusts and always with help of the parents.
In short having said all of the above based on Children’s Right’s the following should be done:
• New comprehensive information programs based on age groups and different abilities for children with special needs.
• More time spent on informing children about their condition, the therapy that we suggest, what other therapies are available, the side effects as well as how much pain they might experience.
• Give children the chance to ask and develop their thoughts by discussing with them honestly.
• Give them the time they need to decide what they want for themselves.
• Find ways to preserve what is classified.
• Ask for their consent to therapy, always between legal boundaries.
• Train the hospital staff on the Children’s Right’s and how they should apply them.
• Make a Chart with the basic Children’s Right’s and hang it in all the welcoming areas and examination rooms of hospitals, clinics and private practices.

Such a chart could be the following :

 

I’M A CHILD AND I NEED AND DESERVE ALL THE FOLLOWING:

 

• To have the best possible care and therapy available.
• To be taken seriously and to be heard.
• To get informed and helped to understand my therapy.
• To ask for help, advice, information and support.
• To be asked before anyone touches me.
• To respect my personal life.
• To have equal rights to therapy and care regardless of my gender abilities and disabilities.
• To not be put down or hurt.

 

All these factors should be put in action and not only words, by pediatricians primarily and all the other healthcare services should follow.

   It could be said that these are all obvious, but in action it has been proven that obvious facts are not enough to make us work together to establish a more productive view that has children more actively in the decision making process of their health care sooner.
   In Greece, up to the present there were only two actions of applying children’s Right’s in Hospital setting. The first regards the publication in 2004 of a leaflet by P. & A. Kiriakou Children’s Hospital. This leaflet brought the following title: “A map of Children’s Right’s” and in a nice and simple way analyzes all previously said along with promises by the doctors and author to respect all hospitalized children.-Image 1-
The second regards an instruction leaflet for children that are hospitalized at the Pediatric Department of “Asklipeio General Hospital” of Voula, based on Children’s Right’s. This leaflet is distributed to every child that is admitted in the clinic. Depending on their age group, along with help from the parents, we try to inform our young patients about their condition and the care that we provide them. The effect of this action on hospitalized children was analyzed on a research that was presented at the 41st Pan-Hellenic Pediatric Congress in 2003. This research was awarded with the First Social Pediatrics Award. It was statistically proven that children that were informed with the leaflet, always with the cooperation of their parents, were disturbed less psychosomatically than the ones that were not informed. Specifically, informed children were much less stressed, happier, friendlier towards other hospitalized kids in the clinic and more cooperative towards therapy. –Image 2-

We have not heard of other applications in Greece, but we want to believe that the Children’s Right’s are always taken under consideration by the responsible organizations that design and apply healthcare facilities for children, such as daycare units, pediatric clinics and hospitals, pediatric private clinics. Unfortunately though, we all know that Children’s Right’s are not applied as widely as they should resulting commonly in solutions that are negative for children. For this reason it is mandatory that we , pediatrician’s remind the responsible authorities that Children’s Right’s exist and that they should be applied both theoretically and practically. Pediatrician’s are the ones that have the duty to apply and guard the Children’s Right’s because if not they will just end up to be a theory and not a responsibility towards our patients, Children.

• The Map of Children’s Right’s, Edited by “P. & A. Kiriakou General Children’s Hospital”, Stella Tsitoura, 2004
• Effect of the Information Leaflet on Hospitalized Children’s behavior and weighting of healthcare facilities in a Pediatric Department, Pediatrics, October 2004, Vol.67 issue 5 pages 336-342.

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