A medical team considers withdrawal of artificial nutrition and hydration supporting a 6-month-old girl with complex cardiac disease, devastating neurological injury, and ongoing, unmanageable pain. Diffuse neurological injury and severe ischemia in all four limbs offers a bleak prognosis. Drawing on the bioethics literature on the subject, the following case presentation and analysis illustrates how a medical team and family can approach such a situation.
When technologically advanced medicine fails to “rescue [a patient] intact from the conditions of her birth,” professionals must rely even more squarely on the foundation of good medicine – human-centered caring. While we do not disagree with Mr. Teti’s ethical analysis, we believe that ethics consultants can (and should) do more to support the medical team in achieving this foundational goal.
These…life-sustaining innovative therapies that require an ethical framework for shared decision-making with families and medical teams. We suggest a way of structuring team education to benefit urgent ECLS decisions for newborns with moderate to severe hypoxic ischemic encephalopathy (HIE).
Doctors revise their diagnostic strategy to provide a timely and meaningful prognosis in accordance with parental goals. This narrative discusses issues of diagnostic uncertainty and the value of relying on clinical gestalt when trying to prioritize medical tests for a sick patient.
Chris Feudtner MD, PhD, MPH delivered the Sanford L. Leikin Memorial Lecture in Pediatric Ethics at Children’s National Medical Center. Here he discuses a case brought by one of the hospital units.
Care providers of critically ill pediatric patients encounter ethically complex and morally distressing situations in their practice. This study sought to identify whether providers remark on ethical conflicts or note moral distress following recent in hospital pediatric death.
The decision to discuss sudden unexplained death in epilepsy (SUDEP) presents a complicated ethical picture with potentially conflicting principles. The neurologist must decide how to disclose and discuss the problem of SUDEP, balancing the desire to help families by empowering them, without doing harm by overwhelming them with fear.
Children are important participants in genetics research, and in genetics research involving children, IRBs must address the primary issues of privacy, confidentiality, informed consent, and the return of results.
In 1995, the medical establishment concluded genetic tests in minors should not be done outside of diagnosis of a treatable disease. The AAP concluded likewise in 2001 and 2013. A new phenomenon is emerging: young women of BRCA positive mothers are requesting genetic testing, and positions have softened with the recognition that some exceptions can be justified.
Since Henry Beecher’s 1966 revelation of the scandal at the Willowbrook School, the ethics of biomedical research involving pediatric subjects has never been the same. Throughout history, the conversation about non-therapeutic pediatric research has moved from access to protection only to return to access once more.