In medical decision making, capable patients have a right to make autonomous decisions. Yet, this principle is often challenged if the patient is a child. Children are often assumed to lack capacity or maturity to make medical decisions, so the task is assigned to the child’s substitute decision maker (SDM), who makes decisions on the child’s behalf. A SDM is supposed to be guided by what is in the child’s “best interests”. Despite being the prevailing ethical principle in pediatric ethics, the best interest standard has faced criticism for being vague, applied inconsistently, and subject to abuse. The result is a confusing body of guidance to assist with making decisions about children’s medical care. Our project seeks to systematically understand how the best interests standard is applied in diverse medical settings with the aim of improving clinical decision-making in this area. The HELP Lab has received a SSHRC Insight Development Grant under the leadership of Dr. Jacob Shelley to fund a project that seeks to provide clarification around the best interests standard.
Project Outcomes: During the course of the Fellowship, Ritchie played a critical role in assisting other members of the HELP Lab who were unfamiliar with bioethics to be brought up to speed. She also led one of the major projects in the SSHRC grant: a scoping review on the best interests standard in children’s decision-making. This project is ongoing, given the number of articles identified in the scoping review, and Ritchie continues to provide leadership to the student team. We anticipate a minimum of one publication from this work, although it is probable that there will be more than one. Additionally, this work will culminate in a minimum of two conference/colloquium presentations.
(1) Smith MJ, Bernard C, Blackman N, Zlotnik Shaul R, Ritchie Z, on behalf of the Ontario COVID-19 Bioethics Table. (2021). Vaccinating Ontarians Aged 12-17: Legal and Ethical Requirements for Consent. May 21, 2021. Submitted to Ontario’s Chief Medical Officer of Health and posted on University of Toronto Joint Centre for Bioethics website.
(2) Ritchie Z, Smith MJ, Gulati N, Teachman G. Legal and Ethical Deliberations in Children’s Healthcare: Identifying Ethical Problems or Scoping Moral Terrain? Poster presented at The Canadian Hospice Palliative Care Association Conference. October 21-22, 2021. Ottawa, Ontario, Canada (Virtual).
(3) Listening to Children in Healthcare Matters: Examining the Intersection of Family-Centred Care, Best Interests, and Children’s Agency. First draft completed (led by Z. Ritchie) – currently being finalized for submission to the Journal of Law, Medicine, and Ethics.