Ethics in Pediatrics
Ethical approach of patients aims at development on the side of health care giver of a respect of morals, respect of rules of right and wrong, doing what is beneficial to the patient and not doing what is harmful. He has to stick to justice and equity in providing needed health care and keeping full confidentiality during his practice.
Ethics in pediatrics cover many aspects of pediatric practice:
1- Attitude and communication
a- Keep calm and decent in dealing with the frightened child and anxious parents.
b- Listen carefully to parents and give chance to express feelings and to ask questions.
c- Avoid being inpatient and intolerant.
d- Be sensitive to patient and parent misunderstanding and anxieties and try to solve them by explanation and assurance.
e- Whenever possible, respond to calls to see a sick child or suggest another to respond on your behalf.
2- Confidentiality
Confidentiality entails assuring the patient or his caretaker that all about their health problem is kept confidential within the needs for health care except on their consent or by force of law. Controversial issues in confidentiality include:
a- Warning others from dangers carried to them through illness of the patient.
b- Telling parents about the adolescent seeking abortion or having sexually transmitted diseases, substance abuse or psychiatric problems.
3- Autonomy versus Paternalism
Autonomy is a human right for the patient to decide about what is to be done with his/her own body. Autonomy requires that the patient or responsible caretaker is competent i.e. can understand the implications of their decisions. They must have a clear explanation about advantages and disadvantages of various options.
A suitable consent must be given before diagnostic/therapeutic interventions.
Paternalism means that the physician decides for the patient. This may be justifiable in some conditions:
- When the patient or his care taker is not considered competent.
- In life threatening emergency conditions when any delay of intervention may be disastrous.
- In case when there is a serious risk to others or to the community. Here intervention is decided for their interest.
4- Rapport
Rapport entails healthy and beneficial relation to all concerned people you deal with.
Good rapport requires optimum use of available potentials to help the patient according to actual needs, respecting justice and equity in providing care. Good rapport also requires that the physician has to respect his own limitations and to resort to timely appropriate referral, and also he must provide needed help to less experienced colleagues.
5- Telling the truth
Generally tell the patient or his caretaker all facts that can help in making their decision for the intervention needed for him, and in complying with suggested intervention plans. In case of serious diseases, a decent approach is needed, always leaving a place for hope.
6- Ethics in screening practice
The screening procedure must be of high predictive value, high sensitivity and specificity in order not to stigmatize subjects wrongly as diseased exposing them to harmful actions and also in order not to miss cases that are amenable to treatment or may represent threatening to others if not detected. A balance between benefits versus harm of detection of a disease state must be considered.
7- Ethics in vaccination practice
You should consider:
a- Benefits versus harm for the individual to be vaccinated.
b- The importance of the vaccination program for community protection is also taken into consideration.
8- Ethics in recording patients data
Any patient data records must be kept confidential. The original entry data must never be changed. If it is necessary to add some details on a later occasion, these should be identified as such and also dated and timed.
9- Ethics in difficult decisions
In case when there is maternofetal conflict
a- Maternal medications that may benefit the mother but may cause harm to the fetus.
b- Interventions beneficial to fetus but may be against maternal interest e.g. cesarean section.
In high risk fetus/newborn
When there is a limited chance of living without disability.
In severely disabled patients
With possible patient/ family / community conflict.
Decision of withholding / withdrawal of life support
- Such a decision necessitates the combined role of physician, patient/care taker and the Ethics
- Committee. It must respect the following rules:
- All facts about the case must be presented.
- Respect all feelings of patient, care taker, family and others concerned.
- Avoid decisions that are based on special (personal) interests.
- Strong emotions are not allowed to obstruct sound critical thinking.
- Consistent policy: similar cases are decided in the same way.