Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Supervisor

Smith, Maxwell J.

2nd Supervisor

Shelley, Jacob

Co-Supervisor

Abstract

‘Best interests’ is a key ethical norm for children’s medical decision-making. While intended to guide parents and healthcare practitioners (HCPs) in their decisions, it has been criticized for its ambiguity and inconsistent application. In the context of childhood vaccination, ‘best interests’ faces unique challenges due to parental vaccine hesitancy, their preventative nature, and their dual benefits to individuals and the public. I employed critical interpretive review (CIR) methodology to analyze 58 empirical and non-empirical publications on children’s best interests and healthcare decisions, including vaccination. I identified five themes that furthered understandings of children’s best interests and healthcare decisions. ‘Best interests’ was not uniformly conceptualized among the reviewed works. The factors that make up a child’s ‘best interests’ were influenced by the various interpretations of ‘best interests’. This thesis provides insights into HCPs’ interpretations of best interests, highlighting areas for further consideration, namely, how to navigate the subjectivity of these decisions.

Summary for Lay Audience

Background: ‘Best interests’ is an important ethical principle for making decisions on behalf of a child who is mentally incapable of making their own medical decisions. It is intended to guide decision-makers, such as HCPs and parents, to make the ‘best’ decision for the child. However, this standard is often criticized for being unclear and applied inconsistently. When it comes to childhood vaccination, decisions become more complex due to factors such as a parent’s reluctance or refusal to vaccinate their child, the precautionary nature of vaccines to protect from an illness that may not seem like a clear threat, and the dual benefits of protecting the individual and contributing to protecting others. This thesis begins to address these matters by exploring the perspectives in both empirical and non-empirical literature on ‘best interests’ and children’s medical decisions including vaccination.

Methods: This thesis employed critical interpretive review (CIR) methodology to review the literature on children’s best interests and healthcare decisions. 58 publications were reviewed, analyzed, and interpreted.

Findings: The findings were organized into five themes or descriptions of important trends and patterns that described how children’s ‘best interests’ were understood and applied. The concept was not consistently conceptualized or applied among the reviewed publications. The factors that made up a child’s ‘best interests’ appeared to be influenced by the varying conceptualizations.

Conclusions: This thesis provides insights into how HCPs interpret the best interest standard in the literature. The findings point to key areas in children’s healthcare decision-making that require further consideration, particularly how to handle the subjective nature of these decisions. This research can help improve the ethical integrity of medical decisions for incapable children.

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