APA SIG: Ethics

Sunday, May 5, 2024

2:00 PM – 3:30 PM ET

Location: Metro Toronto Convention Centre: 713 A

CE: Live CME: 1.5
Ethics CME: 1.5

SIG Chair(s)

Catherine Shubkin, MD, FAAP, HEC-C (she/her/hers)

Associate Professor of Pediatrics
Geisel School of Medicine at Dartmouth
Lebanon, New Hampshire, United States

Slides

Disclosure(s):

Catherine D. Shubkin, MD, FAAP, HEC-C: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Session

Description: Individuals with anorexia nervosa (AN) present providers with a difficult dilemma when the disorder itself is associated with physical, cognitive and emotional impairments which may interfere with decision-making capacity. In patients with AN, the care plan can involve involuntary treatment (refeeding). The approach to navigating adolescent decision making can vary depending on the severity of illness, the capacity of the adolescent and the legal framework under which a medical team must practice. In the United States, clinicians need to adjust decision making frameworks to incorporate the transition from pediatric patients whose parents have the authority to consent, to adolescents, who often have the capacity to assent or dissent to care, to young adult patients who are legally responsible to consenting to their own care presents challenges when severe AN is present. Elsewhere, different challenges arise, for instance in Ontario, Canada, young people are capable of making health decisions until it is proven that are not capable, regardless of age. The care of adolescents with eating disorders can trigger challenging ethical decisions, including decisions to initiate involuntary feeding with nasogastric tubes with or without restraints. Additionally, the necessary loss of decision-making capacity specific to the treatment of eating disorders may directly impact the normal path of adolescent independence. In this highly interactive session, we will have two ethicists, a pediatric hospitalist, a psychiatrist, and an adolescent medicine specialist tease apart the complexities of capacity and consent to consider a framework for ethical analysis to utilize to examine three challenging cases.

Learning Objectives:

Describe ethical issues surrounding capacity and consent to care when faced with adolescents and young adults who require involuntary feeding utilizing physical or chemical restraints.
Apply ethical analysis to understand the complexity in supporting adolescent decision making when the disease (anorexia nervosa) compromises normal adolescent cognitive and emotional development.
Discuss differing constructs of adolescent capacity that may vary on legal jurisdiction or severity of impairment.

Presentations:

2:00 PM – 2:15 PM ET

Ethics SIG: An overview of ethical challenges in the care of adolescents with anorexia nervosa.
Speaker: Catherine D. Shubkin, MD, FAAP, HEC-C (she/her/hers) – Geisel School of Medicine at Dartmouth
2:15 PM – 2:30 PM ET

Epidemiology and challenges in hospitalized patients with anorexia nervosa
Speaker: Valerie J. Riss, MD, MPH (she/her/hers) – The University of Vermont Children's Hospital
2:30 PM – 2:45 PM ET

Ethical constructs in the care of patients with anorexia nervosa
Speaker: Tim Lahey, MD, MMSc, HEC-C (he/him/his) – Robert Larner, M.D., College of Medicine at the University of Vermont
2:45 PM – 3:00 PM ET

Capacity and Consent: a Psychiatrist's View
Speaker: rose geist, MD, FRCP (C), MMUS (she/her/hers) – The Hospital for Sick Children
3:00 PM – 3:30 PM ET

Challenges of consent and capacity: differences in the US and Canada
Speaker: Debra Katzman, MD (she/her/hers) – The Hospital for Sick Children and University of Toronto