Ethical dilemmas for pediatric surgical patients

Children who refuse anesthesia or sedation: a survey of anesthesiologists

“…The question of when does restraint become abuse was discussed in two articles with somewhat emotive titles: an editorial (7) entitled ‘Brute force or gentle persuasion?’ and a refereed opinion (8) entitled ‘Strap him down or knock him out: is conscious sedation with restraint an alternative to general anaesthesia?’ No firm conclusions were reached in these articles; however, institutional or national protocols on the ethical use of restraint in children may be desirable (1,5). A review of the use of medical restraints in emergencies concluded that it is never appropriate to restrain a competent adult against his or her will solely because he or she is refusing treatment suggesting perhaps a different standard for adults compared with children (9).…”

“…Informed consent in children is composed of assent of the child and proxy consent by the parent. Assent has been defined as a developmentally appropriate transfer of information regarding treatment, with subsequent acceptance by the patient (5). The assent of children participating in clinical anesthesia and surgical research has been recently advocated with an emphasis on sufficient information in relation to age and maturity (21,22).…”

“…While the rights of ‘mature minors’ to refuse life‐sustaining medical treatment have also been reviewed (4), there appear to be few guidelines on the management of cases where minors refuse planned surgery. Acting in the child’s best interests is clearly important, and a process of ethical decision making has been proposed, taking cultural, and individual differences and the concepts of beneficence (obligation to do good), nonmaleficence (obligation to do no harm), autonomy and justice, into account (5). Individual institutions may also have guidelines (25).…”

Corneal Cross-Linking for Brittle Cornea Syndrome

“…In terms of general ethical principles, a disagreement between beneficence (preventing a blinding incidence) and nonmaleficence (inducing surgical complications) was identified. 5 In the decision-making process, current scientific data, the preferences of the patient and her parents, and the clinicians' preferences were reviewed. All parties agreed that the risk-benefit ratio was most favorable with a primarily unilateral, modified CXL procedure on the left eye.…”

Znieczulenie bliźniąt syjamskich

“…Thanks to the progress in intensive care, children of considerable degree of prematurity, with various genetic disorders, serious malformations that prevent independent life can be treated, which often raises certain ethical concerns among the treatment team. Despite long-term expensive treatment, many of these children cannot be saved and on many occasions, their treatment leads to severe, irreversible complications [36]. In cases of Siamese twins with conjunction that does not guarantee the survival of both of them (for example thoracopagus with the common heart), it is possible to distinguish at least two opposing points of view of ethicists, lawyers and doctors.…”