Introduction
This topic covers who makes medical decisions when the patient cannot decide alone: children, whose parents or legal guardians act for them, and pregnant women, whose choices can appear to conflict with the interests of the fetus. It links the principles of autonomy, beneficence and non-maleficence with legal limits on surrogate decision making.
Parental authority and the child's best interests
Parents or legal guardians normally consent to treatment for a child who lacks the capacity to decide. Their authority is not unlimited. It exists to protect the child, so it is justified only while the decisions serve the child's welfare.
- Parental responsibility: parents are presumed to act in good faith and to know their child best.
- Limits: parents cannot consent to treatment that is clearly against the child's interests, or to harm that is not justified by a real benefit.
- Emergencies: when a child needs urgent treatment and no guardian can be reached in time, treatment may be given under the general principle of implied consent, with the decision documented and reviewed.