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15 - Ethical issues in pediatrics

Published online by Cambridge University Press:  05 August 2012

D. Micah Hester
Affiliation:
Division of Medical Humanities, University of Arkansas
Toby Schonfeld
Affiliation:
Emory University, Atlanta
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Summary

Objectives

  1. Identify ethical difficulties in the role of parental decision-making.

  2. Discuss pediatric assent and the ability to consent for themselves.

  3. Recognize the diiculty with applying the “best interest” standard for some children.

Case 1

Tommy, 3, sustained a traumatic brain injury (TBI) from a motor vehicle accident. Two weeks into his ICU stay, physicians presented Tommy’s parents with the option to forgo life-sustaining treatments (FLST). After a few days of reflecting and discussing the issue, they agreed that stopping the ventilator was best, but by that time there was a new ICU physician who, after review of Tommy’s condition, did not think that FLST was warranted. With more intensive therapy, Tommy was able to breathe without the vent, and he was moved to the rehabilitation unit. Because of his TBI, however, he continued to be fed through a tube. Neurological scans indicated problems with the basal ganglia, and Tommy’s parents suggested that Tommy’s condition was not in his best interest and asked the palliative care physician about the possibility of stopping feeds. At the same time, the physical and occupational therapists working with Tommy, as well as nurses and social workers from the PICU who came to visit him in rehab, believed they saw slight but noticeable improvements in his cognitive status – possibly tracking, smiling, and reacting to some stimuli. The entire unit, as well as these PICU staff members, is concerned about the ethics of what the parents are suggesting.

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Publisher: Cambridge University Press
Print publication year: 2012

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References

American Academy of Pediatrics, Committee on Bioethics 1995 Informed consent, parental permission, and assent in pediatric practicePediatrics 95 314Google Scholar
Buchanan, ABrock, D 1990 Deciding for Others: The Ethics of Surrogate Decision MakingCambridge, UK: Cambridge University PressCrossRefGoogle Scholar
Diekema, DS 2004 Parental refusals of medical treatments: the harm principle as threshold for state interventionTheor Med Bioethics 24 243CrossRefGoogle Scholar
Guttmacher Institute 2011 http://www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf 2011
Hester, DM 2001 Community as Healing: Pragmatist Ethics in Medical EncountersRowman & LittlefieldGoogle Scholar
Kopelman, L 1997 The best-interests standard as threshold, ideal, and standard of reasonablenessJ Med Philos 22 271CrossRefGoogle ScholarPubMed
Menikoff, J 2002 Law and BioethicsGeorgetown University PressGoogle Scholar
Nelson, HLNelson, JL 1995 The Patient in the FamilyRoutledgeGoogle Scholar
Ross, LF 1998 Children, Families, and Health Care Decision MakingOxford, UK: Oxford: University PressGoogle Scholar
Ross, LFBlustein, JClayton, EW 2008 Adolescent decision makingCamb Quart Hlthcare Ethics 18 302432CrossRefGoogle Scholar
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