Çocuklar ve ergenler aydınlatılmış onam sürecinin neresinde?

Aydınlatılmış onam sürecinde yetişkinler kendilerini ilgilendiren tıbbi kararları verme konusunda oldukça fazla destek görmelerine karşın, çocuklar ve ergenler söz konusu olduğunda durum daha karmaşık bir hal almaktadır. Bu süreçte özellikle ergenler, ebeveynleri ya da yasal olarak sorumlulukları altında oldukları insanların değerlendirdiği yarar algısına göre muamele gören bağımlı çocuklarla, kendi isteklerine göre tedavi edilmesi gereken bağımsız yetişkinler arasında bir yerdedir. Bu bağımlılık ve bağımsızlık arasında olma durumu, özellikle ergenler ile çalışan sağlık personelinin tıbbi karar verme aşamasında birçok etik ikilemle karşılaşmalarına neden olmaktadır. Birçok ülkede olduğu gibi ülkemizdeki yasal düzenlemelere göre bireyler 18 yaşından itibaren yetişkin kabul edilmekte ve kendi tıbbi kararlarını vermeye hak kazanmaktadırlar. Ancak ne hastanın kendi kararını verme hakkı ne de karar verme yetkisinin 18. yaş gününde ortaya çıkmadığı açıktır. Aydınlatılmış onam uygulaması kanuna uymaktan daha ötedir; sağlık personeli için, bireyin özerkliğini, haysiyetini ve kendi kararını verme kapasitesini tanımaya dayanan ahlaki bir sorumluluktur. Sağlık personelinin, ergenlerin ve çocukların aydınlatılmış onam sürecinde yer almaları konusunda etik yükümlülüğü ile ebeveyn hakları konusunda yasalara uyma yükümlülüğü arasındaki dengeyi korumaları gerekmektedir.

Informed consent process: where do the children and the adolescents stand?

Although adults are highly supported to make medical decisions regarding themselves during the informed consent process, when it comes to children and adolescents the situation becomes more complicated. During this process especially adolescents are in a position between dependent children who are treated according to the benefit perception of their parents or legal guardians and independent adults who need to be treated as they demand. During medical decision making process, this position of adolescents causes healthcare personnel, especially the ones who work with adolescents, to face with many dilemmas. According to the legislative regulations in our country, as in many countries, individuals are considered as adults after they turn 18 and become entitled to make their own medical decisions. However it is clear thaneither the right nor the ability to make ones own decisions emerge at the 18th birthday. The practice of informed consent is more than obeying laws; to healthcare personnel it is a moral responsibility based on acknowledging individuals autonomy, dignity and capacity to make their own decisions. Healthcare personnel should maintain the balance between the ethical obligation regarding adolescents and children taking part within the informed consent process and obligation to obey the laws regarding parental rights.

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