The use of antipsychotic medications amongst children has been a hotly debated topic. Medications used to treat psychiatric conditions have their benefits but prolonged use of such also bears certain risks. The fact that a child’s brain is undergoing development makes it easily susceptible to debilitating side effects from long-term use of antipsychotics. Such has implications not only on the physical growth of children but also on their psychological and behavioral adjustments. Ethical issues stemming out of the use of psychiatric medications among the young have for a long time been discussed but there still remains loopholes on the best way to deal with childhood psychiatric disease. This paper seeks to explore these ethical issues based on a recent revelation in a documentary by the FRONTLINE.
In an error where medicine is tightly regulated by international codes of practice and evidence-based approach, the use of antipsychotics among children is dangerous and harmful. There exists limited research on the use of psychiatric medications in children but there has been an alarming increase in their prescription across the United States. Despite the fact that these prescriptions have little or no evidence to back them up, American doctors still go ahead and condemn majority of children to lifelong antipsychotics with numerous side effects. Whereas some pharmaco-therapeutic approaches among children have some benefit, most of antipsychotics remain unapproved by the Food and Drug Agency (FDA). Early introduction of medical interventions in the setting of psychiatric illness is recommended for adults but for children whether to intervene early or delay until full blown symptomatology remains controversial ( Anon, 2018) . Institution of a comprehensive diagnosis before commencing treatment is a safe practice but most doctors do not wait for this. Whether this helps in curbing the illness in its early stages is debatable because these children end up developing disabling side effects from the very drugs.
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The principles of medical ethics should always be the guiding compass when dealing with moral or potentially legal issues in medical practice. At all times, a doctor has the mandate to protect their client and only provide a service if it portents a proven benefit. At the same, the principle of non-maleficence dictates that a health practitioner should avoid acts that are likely to cause harm to their clients. The doctor should act in the best interest of the client, prescribing only that whose benefits outweigh the risks. In the case of use of antipsychotics among children, such drugs must have a benefit that outweighs the risks. In essence, the drug should not cause undue suffering of the patient to the point that this out-balances the illness for which it is being taken. Medical diagnoses and prescriptions that follow them have a huge implication on the life of the patient and the family in terms of finances. Hence, giving out drugs should be guided by the principle of justice and rational use of resources. In the American setting, however, a revelation that most children get prescriptions of one drug to the other is worrying. Children have merely been turned into guinea pigs through the experimentation with the haphazard prescriptions of antipsychotic medications.
Use of antipsychotic medication among children has been associated with numerous side effects. However, the practice of prescribing some of these drugs that have not been studied for use in the young population still persists. There exists a number of other psychotherapeutic approaches that are safer and more effective but are rarely used. Antipsychotic medications work by altering the functional molecules of the brain known as neurotransmitters. These chemical substances also control other functions such as cognition, behavior and movement. Conventional antipsychotics therefore alter the balance of these functions, leading to a plethora of side effects. Such side effects are more pronounced in the developing brain and can lead to permanent disability as described in the testimony of the 5-year old Jacob Solomon in the documentary. Typical antipsychotics cause extra-pyramidal side effects which are disorders of movement. These include tardive dyskinesia, restlessness, dystonia and inability to initiate movement, also known as ataxia ( Olfson, King & Schoenbaum, 2015) . In addition to this, antipsychotic drugs can initiate a convulsion disorder or precipitate an existing one. With all this list of dangerous effects, doctors still get the conviction to prescribe these medications. The result of this has been the current crisis in the number of reported debilitating side effects among children. Exposing children to this plethora of medical perils clearly contradicts the principles of medical ethics.
Antipsychotic medication have a known sedative effect. To administer these medications, children undergo sedation in order to control their irritability. Rendering a child into a semi-comma in order to control psychiatric symptoms infringes on their autonomy and functioning as individuals. This is a form of medically orchestrated assault on a vulnerable individual. Additionally, the use of medications on children is not based on legitimate scientific research but rather on trial and error endeavors. Further, it is important to note that most psychiatric diagnoses are clinical syndromes that are classified based on symptoms rather than actual diagnostic tests. The Diagnostic Statistical Manual (DSM) simply contains a group of illnesses with overlapping symptoms making which leaves a loophole for doctors to make diagnostic mistakes. The haziness of the DSM makes misdiagnose a rampant occurrence, which puts doubts that most of children might actually be receiving antipsychotic medications for a disease they might actually not have. Jacob Solomon’s story is one of such misdiagnoses. Initially, he had been given a diagnosis of attention deficit hyperactivity disorder which was only changed later to bipolar disorder ( Anon, 2018) . This followed a series of change of his medications from one doctor’s visit to another. This story could be similar to that of one million other children diagnosed with early onset bipolar disorder, who are currently under medication in the United States.
There exists little evidence on mental illnesses in childhood, including treatment. This has led to numerous off-label prescriptions which have had a toll on their users in terms of the side effects. Even in this background, advancement of research on medications appropriate to children would be faced by massive ethical issues. First off, children belong to the vulnerable populations that are protected by international codes of ethics such as the Nuremberg Code. Participants in any given research must do so out of their own willingness and an informed consent must be sought. Minors do not have the capacity to understand implications of certain therapeutic trials neither can they give a legally acceptable consent. Consent via a proxy, either a parent or guardian does not necessarily mean that the child would have made the same decision if they were old enough. Additionally, any given research must bear benefits to the society more than it poses risks. Exposing children to medications that ultimately end up hurting them goes against this code. The Declaration of Helsinki provides medical researchers with regulations and responsibilities they must adhere to while handling human subjects. Individuals must be allowed the freedom to withdraw from any interventions at any point of a medical trial. Such decisions can be difficult to consider and make as a minor especially when the decision to use the medication was not yours at the first place. By far, the bearer of burden of hazards of a medical research is the child but not the parent or the guardian who chose that they be involved in the therapy trials ( Olfson, King & Schoenbaum, 2015).
Psychiatric illnesses are treatable by several other psychotherapeutic interventions that have minimal side effects and limit the need for toxic antipsychotic drugs. The ethical controversies surrounding these approaches are also minimal. These options should be tried first before choosing to expose children to drugs that have little evidence support. Recognized psychotherapeutic options include cognitive behavioral therapy, group therapy, family therapy and psychodynamic approaches ( Olfson, King & Schoenbaum, 2015). Such modes of treatment have been proven to be save but physicians still remain skeptical on their use. Qualified professionals should be able to undertake counselling sessions and offer non-pharmacological remedies without hesitation. Unfortunately, the cheaper option is always the use of drugs, some of which are prescribed by inexperienced physicians. Explanation of availability of other options of management of psychiatric illnesses to the parents of ailing children is one of the ethical mandates of a medical practitioner.
In conclusion, prescription of antipsychotics to children has numerous effects, some of which are preventable by adhering to acceptable ethical standards. Giving medications that have no or little evidence support goes against the practice of evidence-based medicine. In essence, the drug should not cause undue suffering of the patient to the point that this out-balances the illness for which it is being taken. Medical diagnoses and prescriptions that follow them have a huge implication on the life of the patient and the family in terms of finances. Ethical issues also arise in the use of off-label medications to treat psychiatric illnesses as though such is experimental. The use of medications appears to be a cheaper option and a “quick-fix” to childhood psychiatric manifestations rather than considering the safer and more superior psychosocial options. Such actions are against the medical ethics contained in the Hippocratic Oath and the Declaration of Geneva.
References
Olfson, M., King, M., & Schoenbaum, M. (2015). Treatment of young people with antipsychotic medications in the United States. JAMA psychiatry , 72 (9), 867-874.
Anon, (2018). [Video] Available at: https://www.pbs.org/wgbh/frontline/film/medicatedchild/ [Accessed 30 Apr. 2018].
