I did temporary restorations for a 3 year old who requires 8 fillings in total(a lot) in my practice as the family is against the child going in for dental treatment under GA
While GA is the best option for the child and i explained this in detail to the parent, their reluctance meant that the child had to have the treamtent in the clinic.
The child did cope but I could only do temporary restoration compared to permanent restoration which could have been placed in theatre.
Arish
ReplyDeleteI can see your ethical dilemma in this scenario, the rights of the parents to make a decision about a GA which does have potential side effects and the rights of the child to endure the discomfort of so many cavities and your rights to only offer temporary treatment when you know the effect of permanent ones would promote better outcomes in health for the child. I have heard our Children's commissioner, Russell Wills speak of child poverty and the use of dental caries as one of the indicators for identifying poverty. From this information, I assume the child has other challenges socio-economically as well. As far as the law goes, the legal guardians are within their rights to say how their child should be treated. But from a moral stance is this in the best interests of the child??? Good example of an ethical issue in your practice.
Arish
DeleteI too have come across situations with parents making decisions for their children I was involved in a sad case of 12 year old who was dying and whose parents were not keen on input from the hospice team until they had a situation when this child was so ill and days away from dying. They also insisted that did not talk about death and dying with her or her siblings and although they did eventually prepare the other children, they did not discuss with their dying child what was happening. We had to accept this situation because first and foremost they needed our trust otherwise our support for that child would not happen. It took a lot of careful communication, we were able to deliver good symptom management and she did die a peaceful death however as health professionals we knew things could have been better for everyone and this caused some distress for the team. I believe the child did have an understanding and perhaps did not ask questions to protect her parents. With more time we could have been able to achieve a lot more but we had to also respect the way this family functioned and we knew the decisions they made for their daughter was out of love and protection for her. We were able to maintain a relationship and support for the family for a long time after with good outcomes, as was possible when grieving for the loss of a child. Parents need time and information but trust and culture of the family will effect outcomes as does the socio economic situation for the parent of the child needing dental care.