All children encounter health care at some point in their lives. Within health care, children face a twofold vulnerability. Being a child they are dependent on adults and being a patient they are dependent on medical professionals. At the same time, medical treatments can be highly intrusive to the integrity of the child and its family. In our modern medical institutions, it is therefore of paramount importance to ensure children’s rights in health care.
In September 2011, the Council of Europe adopted the ‘Guidelines on Child-Friendly Health Care’ (CRC). These guidelines offer a useful tool to identify children’s rights in health care. It is to be awaited how these guidelines will influence the development of the General Comment on children’s right to health that is currently prepared by the Committee on the Rights of the Child. (More information and the submissions achieved)
A key principle in these Guidelines and in the UN Convention on the Rights of the Child, is children’s right to participation. This principle must be applied in medical decisions and organizing medical services. To participate meaningfully, children’s rights to information and to privacy must be guaranteed. To this end, information materials must be child-friendly by making use of cartoons or puppets when communicating with children. Projects such as the ‘Teddy Bear Hospital’, contribute to reducing fear and improving understanding among children in the medical setting.
In applying the principle of children’s participation in health care, the discussion arises how to balance children’s autonomy rights and their right to protection (against themselves). This is the case when children don’t want to undergo a medical treatment or when children want to stay with their heavily maltreating parents. In answering this question, the distinction between long- and short-term autonomy is relevant. Simply put, the decision not to undergo a medical treatment may be respectful of children’s short-term autonomy, whereas this same decision may have serious health consequences and thereby limit children’s autonomy in the long term.
Helpful in determining children’s capacity to participate meaningfully in medical decisions is the concept of ‘evolving capacities’ in article 5 CRC. Children’s developing capacities can be assessed on the basis of their age and their level of understanding. Children’s experiences in the medical setting are also relevant. A 7-year old who has been treated since birth may have developed insights into his needs further than a 15-year old who comes to the hospital for the first time.
Secondly, the role of parents in determining children’s competency to participate in medical treatments must be taken into account. A distinction should be made between children’s competency to take medical decisions and the ability of parents to accept a decision that would lead to the death of their child.
Last but not least, child-friendly health care should approach the child as a child in the first place. Being sick is only a secondary characteristic of the child. Minimize hospital stays and enable children to see their siblings, friends and family. Continue school work and leisure activities. Professionals must look beyond the medical aspects of children’s diseases. To achieve this, training on children’s rights and child specific communication is required: not only for pediatricians, but for all health professionals who encounter children in their work. Child health care should have a human face, so that our children will smile.