Ethics in Pediatric Patient Care

“Why
Bioethics?”
Ambiguity exists in the daily
practice of medicine 

Domen, R. E. (2016). The ethics of ambiguity: rethinking the role and importance of uncertainty in medical education and practice.  Academic pathology 3.
 Major Principles of
Medical Ethics

Principle of respect for autonomy

Principle of nonmaleficence

Principle of beneficence

Principle of justice

Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics 7th edition. Oxford University Press, USA.
 Ethical Problems in
Pediatrics
Physician-patient relationships (29.0%)

End-of-life care (26.2%)

Health professionals conducts (23.8%)

Socioeconomic issues and public health policy (14.8%)

Pediatric Education Process (6.2%)

Guedert, J. M., & Grosseman, S. (2012). Ethical problems in pediatrics: what does the setting of care and education show us?. BMC medical
ethics, 13(1), 2.
 Physician-patient relationships
• To ensure confidentiality, especially in adolescent
care
• To cope with difficult revelations (communication of
bad news, disclosure of diagnosis, disagreement
with diagnosis given by other physician)
• To cope with parents non-adherence to patients'
treatment
• To deal with difficult relationship with the patients'
parents
• To cope with unexpected reactions from family
members
• To manage parents beliefs
• Conflicts involving the autonomy of parents and
adolescents
Guedert, J. M., & Grosseman, S. (2012). Ethical problems in pediatrics: what does the setting of care and education show us?. BMC
medical ethics, 13(1), 2.
 End-of-life care
• To take the decision to withdraw or whether to
withhold or not advanced life support, nutritional
support and resuscitation
• To accept the decision of colleagues of admitting the
patient in the Intensive Care Unit
• To accept the decision of colleagues of prescribing
futile therapies
• To deal emotionally with the situation of patients
without therapeutic perspectives
• To diagnose brain death

Guedert, J. M., & Grosseman, S. (2012). Ethical problems in pediatrics: what does the setting of care and education show us?. BMC
medical ethics, 13(1), 2.
Health professionals conducts
• To disagree with colleagues in the indication of
procedures
• To witness workplace inappropriate attitudes of
colleagues in their relationship with patients and
other colleagues
• To disagree with inappropriate personal attitudes
of physicians from other workplaces
• To disagree with inappropriate patient relationship
of physicians from other workplaces
• To disagree with the breach of confidentiality,
inappropriate use of medicines or inappropriate
personal attitudes of other health professionals

Guedert, J. M., & Grosseman, S. (2012). Ethical problems in pediatrics: what does the setting of care and education show
us?. BMC medical ethics, 13(1), 2.
 Socioeconomic issues and public
health policy
• To have to take decisions when the absence of
inpatient beds threatens the lives of patients and
surgeries are postponed;
• To cope with the social reality of patients, which
imposes limits to the adequate management of
care, resulting in lack of therapeutic success;
• To cope with the difficulty in referring patients to
specialists;
• To cope with problems in the health care system
that result in difficulties for patients to have
access to more sophisticated diagnostic exams
and to surgeries.

Guedert, J. M., & Grosseman, S. (2012). Ethical problems in pediatrics: what does the setting of care and education show
us?. BMC medical ethics, 13(1), 2.
 Pediatric Education Process
• To witness medical undergraduate students disrespect
for the university hierarchy
• To experience problems such as the allowance by
teacher/physician supervisor to residents to act when
there is risk to the patient
• To experience problems in the relationship
professor/physician supervisor-patient, such as
inadvertent exposure of patients and discussion of
cases in corridors
• To experience problems in the relationship between
teachers/physician supervisors, such as public criticism
and disrespect authorship in scientific publication;

Guedert, J. M., & Grosseman, S. (2012). Ethical problems in pediatrics: what does the setting of care and education show us?. BMC medical
ethics, 13(1), 2.
You treat a disease,
you win, you lose.
You treat a person,
I guarantee you,
you'll win,
no matter what
the outcome
Patch Adams Movie
 Children are the most vulnerable
citizens in any society and the
greatest of our treasures

 
(Nelson Mandela: Nobel Prize ceremony, Oslo, Norway, 1993)