Bioethics Forum Essay
What Are the Rules for Ethical Medication of Migrant Kids?
Reports that migrant children held by the Office of Refugee Resettlement are being drugged require an immediate and unambiguous response by the Trump administration. According to court filings, the drugs that are alleged to be among those given to children without their parents’ consent include clonazepam, duloxetine, guanfacine, geodon, olanzapine, latuda and divalproex.
Drugging children without consent or adequate follow-up is a gross violation of their rights and welfare. The effects of these powerful psychotropic medications must be carefully monitored, especially in children whose reactions may be unpredictable and whose medical histories are unknown.
The government has a special moral burden to take extreme care in these cases because the children have been forcibly separated from their parents, their natural protectors and surrogate decision-makers. At the very least before any drug is given a local magistrate should appoint a legal guardian to represent the child’s best interests and a psychiatrist should be consulted, approve and monitor the child’s care. This must not be merely a paper process. The guardian and the psychiatrist must actually interview and observe the child. They are accountable for the child’s welfare.
Too often mental health care drugs have been used to make the job of caregivers easier rather than in the service of the patient’s best interest. Especially when children are isolated from their families that balance must be carefully and independently assessed.
In a situation in which the local caregivers are not even allowed to physically comfort very young children, some younger than four years old, they are put in a morally unacceptable position and require the assistance of a legal guardian and qualified physicians in making medication decisions.
The greatest fear of any parent is that their child is being neglected or subjected to dangerous conditions. All parents can easily identify with those fears.
Beyond the moral and humanitarian issues, if adequate medical and psychological safeguards are in place to protect these children and minimize the emotional damage to which they have already been subjected American taxpayers deserve to know what they are.
These innocent victims of adult politics deserve protection from a confusing and often cruel world they didn’t create. The president and his administration should step up and make sure that these children are not being mistreated or abused.
Jonathan D. Moreno, PhD, is the David and Lyn Silfen University Professor of Ethics at the University of Pennsylvania and a Hastings Center Fellow. Arthur Caplan, PhD, is the head of NYU School of Medicine’s Division of Medical Ethics and a Hastings Center Fellow. This essay originally appeared on the blog of Psychology Today.
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I am commenting to agree, wholeheartedly, with Moreno and Caplan’s call for a decisive response to the use of psychotropic medications in migrant children. The forcible separation of a child from their caregiver is, without a doubt, a traumatic event. This chasm disrupts numerous processes necessary for healthy development, among which is the ability to regulate emotions. As a result, it is not surprising that children who have been forcibly separated from their parents exhibit behaviors such that may be interpreted as symptoms of mental illness. While providing psychotropic medication to help a child cope with feelings of anxiety, fear, depression, and anger may seem humane, it is simply unethical to do so without clear consent. Consent relies upon capacity. Medical decision-making capacity depends on an individual’s ability to demonstrate understanding of the benefits and risks of, and alternatives to, proposed treatment or intervention, including no treatment (Barstow, Shahan, & Roberts, 2018). The sheer stress of being separated from one’s family and held indefinitely in an unfamiliar, unstructured environment is enough to impair one’s decision making. On top of this is the fact that the area of the brain responsible for complex decision making is not fully developed in children, causing them to make more impulsive and potentially risky decisions. Given the fact that side effects of psychiatric medications in adolescents can include increased suicidality, the implications of these decisions may be a matter of life or death. It is the government’s responsibility to ensure that any child separated from their parents due to public policy is provided with a culturally competent and independent advocate. Any use of psychotropic medications must be approved by a multidisciplinary team of providers trained not only in psychiatry, but also psychology, social work, nursing, ethics, as well as experts in emergency response management. Without such provisions we risk further compromising the mental as well as physical health and well-being of these children.
Barstow, C., Shahan, B., & Roberts, M. (2018). Evaluating medical decision-making capacity in practice. American Family Physician, 98(1), 40-46.