Incompetent Child Analysis

There are studies that focus on the competencies of children in health care decisions, yet do not explicitly mention much about the perspectives of incompetent children. Incompetent children and adolescent patients could be infants, young children, or young persons with mental illnesses or disabilities that could affect their mental and decisional capacities to make well informed health care decisions, and are assumed to require the assistance of substitute decision-makers to make decisions in the child's best interests when the incompetent child could express their approval or disapproval of a treatment. This "mature minor" notion recognizes that some children are capable of making their own health care choices despite their age (Harrison,

Young children and adolescents who do not have fully developed cognitive abilities are seen as incompetent. To be competent is to have the ability to understand and appreciate the consequences of treatment and non-treatment, and in Canada, patients are presumed competent until shown otherwise. Competence models for adults presume that "patients are autonomous, have a stable sense of self, established values, and mature cognitive skills" (Harrison, 1997, p. 30), all of which are underdeveloped in children. There should be a continual review of a child's competence because children's cognitive abilities are still developing. When investigating the competency of a child, qualitative social research is the better approach than developmental psychological research because it is informed by critiques of the child development theory to investigate how children's competencies are recognized, denied, encouraged or inhibited (Alderson, 2013). Qualitative social researchers establish a friendly rapport and interactions with children to better understand their perspectives and reasoning instead of using study methods that detach themselves from the children which could make them nervous and underperform in the conducted studies. Through this method of assessment, it has been shown that children with chronic illnesses or disabilities

However, health care providers and substitute decision-makers must consult and involve incompetent patients in the decision-making process to the greatest extent possible, because it is a moral requirement for child patients. Substitute decision-makers are obliged to make treatment decisions in the child's best interests and if the health care provider suspects otherwise, they can appeal to provincial child welfare authorities (Harrison, 1997, p.31). Involving incompetent children in decision-making is a moral requirement because the child has the right to know what treatment they will be undergoing and its risks and benefits before consenting to the treatment. The use of age-appropriate discussions are helpful to children and adolescents who are seriously ill because it will help them develop an understanding of the issues regarding their health care decisions (Harrison, 1997, p. 32). In the end, the patient is the child, not the parents, and physicians should ensure that the decisions made are in the child's best