Honoring Patient Autonomy: Applying principle of autonomy in children at home

Question: We speak about patient autonomy in our noble field of palliative care. How often have we applied this principle to children at home? 

Answer: Autonomy is defined as the right of a person, irrespective of age or gender, to govern their own affairs. 

In palliative care settings, this terminology is widely used to ensure a genuine and meaningful approach toward patients, particularly in handling end-of-life care. Various counseling sessions are held with caregivers and the medical team to arrive at a mutual consensus regarding management protocols. 

Today, the question is whether we apply this principle while parenting our own children. Are we justified in how we handle them and the advice we offer? 

Personal Opinion 

 When dealing with a terminally ill patient, our aim as counselors is to offer them a peaceful farewell, filled with love and dignity. Since the patient has a limited lifespan, and we lack knowledge about life beyond death, our primary focus is on ensuring their comfort. In this context, it is rare to make mistakes because the approach revolves around respect and compassion. 

Consider a 78-year-old patient who is physically and emotionally fit but has difficulty walking due to arthritis. She is hesitant about undergoing bilateral knee replacement surgery. As doctors, we know that limited mobility will not only disrupt her social life but may also lead to dementia. While respecting her autonomy, it is crucial to explain the benefits of the surgery and guide her toward a decision that adds quality to her life.   

Respecting a child’s autonomy is essential. Acknowledging their likes and dislikes helps nurture trust and respect. However, children often lack the ability to foresee long-term consequences. Parents, using their knowledge, maturity, and experience, must guide their children in making sound decisions about critical aspects of life, such as behavior, education, relationships, and habits. 

Guiding children with love and caution is not a violation of their autonomy. If parents fail to offer this guidance, children may feel lost, ignored, or even blame their parents for a lack of direction. While hobbies and passions should be encouraged, growth must be gradual, guarded, and appropriately geared. 

For example, I have encountered children passionate about riding powerful bikes or performing stunts, resulting in severe accidents that left them bedridden. Similarly, children eager to dive into extreme sports without proper preparation have suffered life-changing injuries. It is our responsibility to ensure children are aware of their limitations and the need for preparation before taking risks. 

Children are our future. If we don’t guide them, we risk fostering a weak society, which is detrimental to the nation. Therefore, while parenting, respect children’s views, likes, and dislikes, but guide them with love and caution to prepare them for the challenges of the world.