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Ayesha Kadir MD Gonca Yilmaz MD, PhD
IntroductionWhat participation means, from the UNCRCArticle 12 and linked articlesThe ladder of participationBarriers to child participationThe benefits of participationWhat can we do as an health care professional?
General discussion and questions
Types Of Rights 54 Articles
Three types of rights Protection Provision Participation
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General Principles Underlying The UN Convention
Article 2 – all the rights in the Convention apply to all children without discrimination on any grounds
Article 3 – in all actions affecting children their best interests must be a primary consideration
Article 6 – all children have the right to life and optimal survival and development
Article 12 – all children, capable of expressing a view have the right to express that view freely and to have it taken seriously, including in judicial and administrative proceedings affecting the child, in accordance with their age and maturity
4
Article12 CRC
Where should participation take place?
At hom
e
In scho
ol
In hospita
ls
In courts
In culture and the
arts
In play and
recreation
In local governmen
t
In conferenc
es
In governmen
t policy
In international forums
In local communitie
s
In other words, at all levels of society and in all settings
Child participation
Why does participation matter?
Article 5 implies that health care providers have both an obligation and an opportunity to:
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Participation and the realisation of rights
Participation
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Participation in practice
Alderson and Montgomery (1996) define four levels at which children can
participate;
1. Being informed 2. Expressing a view 3. Influencing a decision 4. Being the main decider
What do you feel are the barriers to greater participation by children in their own health care?
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Arguments against medical child participationChildren lack the competence or experience to
participation.
Adult’s instincts to protect children from distressing information.
İt will infringe upon the rights of parents.
Children’s rights is a Western concept being imposed on other countries.
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What are the barriers facing children?
Attitudes and assumptions
Physical environment
Lack of training and skills
Lack of confidence
Lack of funding
Failure to commit time
Lack of accessible transport
Right To Participation Frequently violated in
paediatric practice: Children often excluded Opinion/consent not
sought Good practice but rare
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At what age do you consider children to be competent to take responsibility for their own health care?
Why?
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Very young children taking decisions that affect their health, examples:Three-year-old Maisie was able to warn her mother
when she was feeling shaky from low blood sugar. Ruby at four years of age could be trusted not to
eat chocolates when her friend did and no adults were present, and by the age of five she was able to test her own blood sugar and decide how much cake she could eat.
Ahmet, a 8 year boy with acute lymphoblastic leukemia(ALL) was able to pay attention to his white blood cell count.
Jill, at 3 years of age, reminds her mother when it was time for her to take her HIV medicines
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What changes might be necessary in your practice or hospital to move toward a culture of greater respect for children’s participation in their own health care?
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Avoid talking over the child’s head: children get distressed when doctors talk directly to their parents without involving them.
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Give children the opportunity to ask questions and explore their concerns and deal with themhonestly and FULLY.
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A 10 year old boy is admitted to the hospital in the middle of the night and prescribed an intravenous infusion.
He refuses.
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A 20 month old boy is about to inhale medicine to expand the bronchi. The first inhalation goes fine, but the next he refuses.
What would you do as an health professional?
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Article 16 – the right to privacy and respect for confidentiality
25
Develop policies on confidentiality.
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What about seeing a child on his- her own?
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Develop policies on consent to treatment.
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Medical consent to treatmentSome countries have introduced a fixed age
Age threshold
Combine system
Some countries adopt an approach that gives the parents a gradually decreasing role
No age treshhold21.04.23 29
Consultation Plan
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Child -young person
Waiting room
Communication with the child
Informing children about therapy
Provision of information
Informed consent
Advocacy
Resources Goldhagen, J., Waterston, T. Child Rights Training Programme – available
from ESSOP www.essop.org or: CHILD data set is available at http://www.europa.eu.int/comm/health/ph/programmes/monitor/fp_monitoring_20 00_frep_08_en.pdf .
Simonelli F and Guerreiro AIF (eds); Self-evaluation Model and Tool on the Respect of Children’s Rights in Hospital (2009) an d The respect of children’s rights in hospital: an initiative of the International Network on Health Promoting Hospitals and Health Services . Final Report on the implementation process of the Self-evaluation Model and Tool on the respect of children’s rights in hospital. January 2010, both available:
http://www.hphnet.org/index.php?option=com_content&view=article&id=1551% 3Ahp-for-children-a-adolescents-in-a-by-hospitals-&catid=20&Itemid=95
(last accessed on 23 November 2011) United Nations Children’s Fund. Convention on the rights of the child.
Available at: www.unicef.org/crc
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Cases1 Fatma is an 8- year old girl of an Egyptian family that
lives in Turkey. She is healthy and visited you for a child care visit. Family makes plans for their 8-year old girl to undergo female genital mutilation.
2 A 12 year old girl, Sue, with terminal acute lymphoblastic leukemia(ALL) refuses therapy and wants to go home.
3 A 14-year-old girl, Merry, visits your outpatient clinic. She is anorexic and looks exhausted. Family doesn’t want her hospitalization. When you are talking with her, you learn that she was inseminated by her uncle and became pregnant
4 A 10-year-old boy, Tim, develops enuresis nocturna. You performed all laboratory tests and diagnosed ‘depression’. You sent him with antidepressive drug to home.
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Case 1.Fatma is an 8- year old Egyptian girl, living in
Turkey. She is healthy and visited you for a pre-travel health care visit. While her vital signs were taken, the clinic nurse overheard Fatma’s older sister speaking about plans for Fatma to undergo female genital mutilation.
Which rights are at stake for the child and parent?
What would you do in this situation?21.04.23 33
Case 2.A 12 year old girl, Sue, with terminal acute
lymphoblastic leukemia(ALL) refuses therapy and wants to go home.
Which rights are at stake for the child and parent? What would you do in this stiuation?Who would you go for guidance?
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Case 3.A 14-year-old girl, Merry, visits your outpatient
clinic. She is very thin and tired appearing. And you are concerned about anorexia. You ask to her speak her alone and learn that she has been brought in by her father for medical care because she is pregnant. She tells you that her uncle is father.
Which rights are at stake for the child and parent? Which rights would you prioritize? Why? How would you resolve the potential conflict?
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Case 4.A 10-year-old boy, Tim, develops nocturnal
enuresis. After full evaluation, you diagnose him with ‘depression’ and prescribe antidepressant medication.
Which rights are at stake for the child and parent?
Which rights would you prioritize? Why? How would you resolve the potential conflict?
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Thank you!
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