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Proxy Decision Making


Medical proxy decision making means someone who is not receiving the
treatment has the right to make medical decisions for the patient who is receiving
treatment. Parents are mandated to make medical decisions for their children under the
age of 18, therefore leaving children with limited or no autonomy. According to Mark
Cherry in the article Ignoring the Data and Endangering Children: Why the Mature
Minor Standard for Medical Decision Making Must Be Abandoned proxy decision
makers are necessary because children lack the cognitive abilities to make their own
medical decisions. Although it is necessary to have proxy decision makers for children, I
will argue that parents are not always the best option. Edwin Hui writes about the
assumptions as to why parents are proxy decision makers and how these assumptions
arent always correct in the article Parental Refusal of Life-saving Treatments for
Adolescents: Chinese Familism in Medical Decision Making Re-visited. In the article
Do parents or surrogates have the right to demand treatment deemed futile? Clare
Clarke explains the parents right to autonomy and how some of their emotional
connections to their children become barriers in deciding the patients best interest.
Scientifically, the brain of a child lacks a mature frontal lobe which is essential for
reasoning. Because of their immature brain development, children have limited autonomy
regarding medical decision making. As Mark Cherry points out, all children need some
type of proxy decision makers but not necessarily their parents. Some will argue children
can be mature minors and should then, in fact, be presumed to have capacity to refuse
medical treatments if they were 14 years old and above. Cherry proves that there is no

such thing as a mature minor. The mature adolescent has the ability to understand risky
behavior, but not the emotional or cognitive control personally to refrain from such
behavior. In fact, the brain doesnt fully mature until age 21. The mature minor
standard for medical decision making ignores the scientific data and endangers children
(Cherry, 326). Parents are presumed to be these proxy decision makers, but is this always
the best choice for the childrens well being? In my opinion, no it is not because they
have too much of an emotional connection to lack a clear understanding of the situation
medically. Instead, it is suggested that the medical team have more of a say in what
would be best for the patient. From a medical perspective, which lacks an emotional
connection, the positives and negatives can be weighed in order to choose the treatment
that will be in the patients best interest.
Clare Clarke points out that parents can let their emotional connection get in the
way of making appropriate medical decisions for their children. In the article, although
the parents right to autonomy is considered, the medical team deemed treatment of Baby
L to be futile. Because the parents had an emotional connection to their baby, their love
made it impossible to allow their baby to die. As Clarke writes, Zawacki refers to this as a
side benefit where the parents benefit from keeping the baby alive instead of the patient
(or baby) getting the benefit. The parents would get the benefit in keeping Baby L alive
rather than Baby L himself getting the benefit. This then means that the parents are not
acting in their childrens best interest. It is suggesting by Halliday (1997) that the idea of
keeping a patient alive purely for the benefit of the family is repulsive (Clarke, 759).
Looking at Baby Ls best interest, it is wrong to allow the parents to continue treatment
for their own benefit and suggests that they lack the ability to let their baby die because

of an emotional connection. It is essential to get a second opinion on medical decision


making in order to make a compromise but parents are not the best option for this reason.
Although the parents views should be taken into account, they have no veto.
According to Hui, parents are subject to make medical decisions for their children
because of a few assumptions. One assumption is that children are too immature to make
these decisions. Because of Cherryss article, we know this to be true. Another
assumption is that parents will always act in their childrens best interest. This is not
correct to assume though. For example, parents know fast food isnt healthy but yet they
take their children there to eat anyways. In the case of the Confusionist Chinese fathers in
the article, choosing to refuse treatment deemed necessary to sustain their childrens life,
were they looking out for their childrens best interests or their familys? I would say they
were looking at their familys best interest by making their decisions based on their
culture rather than their childrens by refusing life preserving treatment. Saying parents
can make these medical decisions as long as they have the childs best interest in mind is
not clear enough. Hui also presents self-ascribed and other-ascribed interests. Selfascribed interests are what the patient wants out of the situation. Other-ascribed interest
means someone else decides what the patient wants out of the situation. Because of the
Confusionism way of authoritarianism, the fathers are ascribing their interests for their
children. Just because these fathers believe their children should not receive the life
preserving treatment based on their culture, should they then not be allowed to receive it?
Parents should not be childrens proxy decision makers because they can allow their own
culture to get in the way of the childrens well being without intending to.

Proxy medical decision making is necessary for children under the age 18. Parents
are not always the best option for making those decisions though. The answer should not
be a mature minor standard where if the child is over the age 14, they can make their
own medical decisions without a proxy. Children lack the cognitive ability to reason out
and make these decisions until after the age of 18. There are a number of assumptions as
to why parents are the proxy decision makers for their children that are not clear enough.
Last, parents can let their emotional connection get in the way of the patients best
interest. As for the future of proxy decision making for children, it is necessary to appoint
someone who is capably of looking at what benefits the patient medically without
emotionally getting involved.

References
Cherry, M. J. (2013). Ignoring the Data and Endangering Children: Why the Mature
Minor Standard for Medical Decision Making Must Be Abandoned. Journal of
Medicine & Philosophy, 38(3), 315-331.

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