Withholding and withdrawing life-sustaining treatment in a patient's best interests : Australian judicial deliberations

•Intractable disputes about withholding and withdrawing life-sustaining treatment from adults who lack capacity are rare but challenging. Judicial resolution may be needed in some of these cases. •A central concept for judicial (and clinical) decision making in this area is a patient's “best interests”. Yet what this term means is contested. •There is an emerging Supreme Court jurisprudence that sheds light on when life-sustaining treatment will, or will not, be judged to be in a patient's best interests. •Treatment that is either futile or overly burdensome is not in a patient's best interests. Although courts will consider patient and family wishes, they have generally deferred to the views of medical practitioners about treatment decisions.

Issues to consider when developing mandatory reporting legislation and policy to improve discovery of child abuse

In the United Kingdom, recent investigations into child sexual abuse occurring within schools, the Catholic Church and the British Broadcasting Corporation, have intensified debate on ways to improve the discovery of child sexual abuse, and child maltreatment generally. One approach adopted in other jurisdictions to better identify cases of severe child maltreatment is the introduction of some form of legislative mandatory reporting to require designated persons to report known and suspected cases. The debate in England has raised the prospect of whether adopting a strategy of some kind of mandatory reporting law is advisable. The purpose of this article is to add to this debate by identifying fundamental principles, issues and complexities underpinning policy and even legislative developments in the interests of children and society. The article will first highlight the data on the hidden nature of child maltreatment and the background to the debate. Secondly, it will identify some significant gaps in knowledge that need to be filled. Thirdly, the article will summarise the barriers to reporting abuse and neglect. Fourthly, we will identify a range of options for, and clarify the dilemmas in developing, legislative mandatory reporting, addressing two key issues: who should be mandated to report, and what types of child maltreatment should they be required to report? Finally, we draw attention to some inherently different goals and competing interests, both between and within the various institutions involved in the safeguarding of children and the criminal prosecution of some offenders. Based on this analysis we offer some concluding observations that we hope contribute to informed and careful debate about mandatory reporting.

Physical activity-related and weather-related practices of child care centers from 2 states

© 2015 Human Kinetics, Inc.Background: Young children's physical activity (PA) is influenced by their child care environment. This study assessed PA practices in centers from Massachusetts (MA) and Rhode Island (RI), compared them to best practice recommendations, and assessed differences between states and center profit status. We also assessed weather-related practices. Methods: Sixty percent of MA and 54% of RI directors returned a survey, for a total of 254. Recommendations were 1) daily outdoor play, 2) providing outdoor play area, 3) limiting fixed play structures, 4) variety of portable play equipment, and 5) providing indoor play area. We fit multivariable linear regression models to examine adjusted associations between state, profit status, PA, and weather-related practices. Results: MA did not differ from RI in meeting PA recommendations (β = 0.03; 0.15, 0.21; P = .72), but MA centers scored higher on weather-related practices (β = 0.47; 0.16, 0.79; P = .004). For-profit centers had lower PA scores compared with nonprofits (β = -0.20; 95% CI: -0.38, -0.02; P = .03), but they did not differ for weather (β = 0.12; -0.19, 0.44; P = .44). Conclusions: More MA centers allowed children outside in light rain or snow. For-profit centers had more equipment-both fixed and portable. Results from this study may help inform interventions to increase PA in children.

Working together? Parent and local authority views on the process of obtaining appropriate educational provision for children with autism spectrum disorders

Background: There is general agreement across all interested parties that a process of working together is the best way to determine which school or educational setting is right for an individual child with autism spectrum disorder. In the UK, families and local authorities both desire a constructive working relationship and see this as the best means by which to reach an agreement to determine where a child should be educated. It has been shown in published works 1 1. Batten and colleagues (Make schools make sense. Autism and education: the reality for families today; London: The National Autistic Society, 2006). View all notes that a constructive working relationship is not always achieved. Purpose: This small-scale study aims to explore the views of both parents and local authorities, focussing on how both parties perceive and experience the process of determining educational provision for children with autism spectrum disorders (ASD) within an English context. Sample, design and method: Parental opinion was gathered through the use of a questionnaire with closed and open responses. The questionnaire was distributed to two national charities, two local charities and 16 specialist schools, which offered the questionnaire to parents of children with ASD, resulting in an opportunity sample of 738 returned surveys. The views of local authority personnel from five local authorities were gathered through the use of semi-structured interviews. Data analyses included quantitative analysis of the closed response questionnaire items, and theme-based qualitative analysis of the open responses and interviews with local authority personnel. Results: In the majority of cases, parents in the survey obtained their first choice placement for their child. Despite this positive outcome, survey data indicated that parents found the process bureaucratic, stressful and time consuming. Parents tended to perceive alternative placement suggestions as financially motivated rather than in the best interests of the child. Interviews with local authority personnel showed an awareness of these concerns and the complex considerations involved in determining what is best for an individual child. Conclusions: This small-scale study highlights the need for more effective communication between parents of children with ASDs and local authority personnel at all stages of the process

In whose interests? The best interests principle under ethical scrutiny

This paper critically examines the best interests principle and its role in making decisions about intensive care treatment. In current practice the best interests principle is sometimes relied upon to guide decision making in circumstances when the patient is incompetent, although it is intrinsically linked to inconsistent assumptions about what is meant by quality of life. This situation means that there is potential that moral errors will be made that may result in an unwanted extension of life for some individuals or the premature death of others.

It is difficult to justify such decision making on ethical grounds. A greater understanding of the best interests principle, and consequently the concept of quality of life, is needed in order to ensure that decision making about intensive care is ethically defensible. It is argued that an ideal theory of quality of life provides an appropriate framework for best interests decisions, and that the decision making process ought to, whenever possible, involve the patient's close family.

The importance of degree versus type of maltreatment: a cluster analysis of child abuse types

The author conducted secondary data analysis of 3 previously reported studies (D. J. Higgins & M. P McCabe, 1998, 20(K)b, 2(X)3) to examine whether respondents are best classified according to their experience of separate maltreatment types (sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence) or whether their experience reflects a single unifying concept: child maltreatment.

Understanding parental motivators and barriers to uptake of child poison safety strategies: a qualitative study

Objectives: To develop an understanding of factors acting as barriers and motivators to parental uptake of child poison safety strategies.

Design: A qualitative study involving semistructured interviews and focus groups. A grounded theory approach was used for the collection and analysis of data.

Participants: Sixty five parents of children under 5 years of age, some of whom had experienced an unintentional child poisoning incident.

Results: A range of knowledge based, environmental, and behavioral barriers to comprehensive parental uptake of poison safety practices were identified. As a result there tended to be only partial implementation of safety initiatives in the home. Selection of safety practices was often guided by the interests and behaviors of the child. This made the child vulnerable to changes in the home environment, inadequate supervision, and/or shifts in their own behavior and developmental ability. Personal or vicarious exposure of a parent to a child poisoning incident was a significant motivator for parental review of safety practices.

Conclusion: Environmental measures targeting child resistant containers, warning labels, and lockable poisons cupboards will support parents’ efforts to maintain poison safety. Additional education campaigns using stories of actual poisoning incidents may help to increase awareness of risk and encourage increased uptake.

Child testimony in custody cases: a review

The authors provide a brief historical review of judicial trends in child custody placement. In contrast to the start of the 19th century, by its end, courts took into consideration children's best interests, maternal rights, and prevailing sex role ideologies. Statutory changes began to reflect similar concerns by the end of that century. Modern practices, relying on the best interests of the child standard, also include consistent consideration of children's preferences in making custody determinations. An important factor in this context is the accuracy with which a child describes domestic relations, especially in contested cases with contradictory allegations by parents. Research dealing with children's report accuracy and techniques to enhance it are reviewed, and a description of various practical considerations when questioning children is provided.

A theory of injustice: the flip side of the relocation coin in Australia

Problems attached to relocation cases in Australia because of geographical and cultural reasons - the best interests of the child principle inherently promotes injustice in relocation cases - operation of Part VII of the Family Law Act in the context of relocation cases - assessment of the best interests of the child principle in Australian relocation cases - responsibility of contact parents - reforming Australian law to promote an equality of interests.

A case study of child sexual abuse within a Church community

A case study is presented of child sexual assault within a church community. How does a church community deal with the accusation of an adolescent female that-as a 13-year old-she was sexually victimised and assaulted by her then 18-year old boyfriend, five years her senior? Practical and pastoral issues, as well as ethical and legal concerns are addressed. Consideration is also given to the theological context of the church environments in which the situations arise. The implications for victims, perpetrators, leaders, and the church community of our actions-and failure to take appropriate action-are described, along with recommendations for prevention, and best practice in dealing with the sexual abuse of minors within church communities.

Child protection, risk assessment and blame ideology

In this article we use qualitative data drawn from a sample of child protection cases 10 demonstrate holV the process of al1ributing blame to parents and carers for child maltreatment is a sign!ficanr influence 011 decisionmaking,
sometimes to the detriment of assessing the flltllre safety of children. We foctls on two cases which both demonstrate how the process of apportioning blame can lead to decisions which might not be considered 10 be in the best interests of the children concerned. We conceptualise blame as an 'ideology' with its roots in the discourse of the 'risk society', pelpetuated and sustained by the technology of risk assessment. The concept of blame ideology is offered as an addition to theOlY which seeks 10 explain the influences on decision making in child protection practice.

An analysis of police officers decisions about whether to refer cases of child abuse for prosecution

In many jurisdictions, police officers are responsible for deciding whether cases of child abuse are referred for potential prosecution. Such discretion justifies the need to scrutinise these professionals' decisions to determine if they are consistent with the scientific eyewitness memory literature. Prior research has shown that interviewer questioning is one of the most critical factors impacting the reliability of child witness statements. Hence, we asked: 'To what degree do officers' consider the quality of interviewer questions when making case authorisation decisions?'. In order to answer this question, we conducted a thematic analysis to identify issues referred to in a sample of documented police correspondence (n=33) about potential prosecution of child abuse cases. Two key themes emerged: the existence of corroborative evidence and whether the suspect denied the allegations. Questioning technique, however, was not considered. All but one decision that referred to interview process focused on the presentation of the witness, even though the witness interviews (as a whole) did not adhere to recommended best-practice guidelines. The implications of these findings are discussed.

Accepting the unacceptable : patriarchal hegemony and child support arrangements

This research explored how low-income single mothers' child support decisions were based on the 'best interests of the child'. While mothers desired joint financial responsibility for children, poor payment outcomes made mothers financially dependent on the state and resulted in single mothers' coerced acceptance of unacceptable child support arrangements.