Fifty years of paediatric ethics

Abstract

In 1965, when the first issue of Journal of Paediatrics and Child Health appeared, medical ethics was just becoming established as a discipline. The sub-speciality of paediatric ethics did not make an appearance until the late 1980s, with the first key texts appearing in the 1990s. Professional concern to practice ethically in paediatrics obviously goes much further back than that, even if not named as such. In clinical areas of paediatrics, the story of the last 50 years is essentially a story of progress - better understanding of disease, better diagnosis, more effective treatment, better outcomes. In paediatric ethics, the story of the last 50 years is a bit more complicated. In ethics, the idea of progress, rather than just change, is not so straightforward and is sometimes hotly contested. There has certainly been change, including some quite radical shifts in attitudes and practices, but on some issues, the ethical debate now looks remarkably similar to that of 40-50 years ago. This is the story of some things that have changed in paediatric ethics, some things that have stayed the same and the key ethical ideas lying beneath the surface.

Decision making in pediatric oncology: Views of parents and physicians in two European countries

“…Decision making for pediatric patients is no longer a practice solely based on a clinician-centered model (Charles et al 1999;Gillam 2015;Laine and Davidoff 1996;Whitney et al 2006), but features collaboration between three parties (Lipstein et al 2014;Whitney 2008;Whitney et al 2008). Known as shared decision making, this model is the guiding process in all physician-patient-parent interactions in health care (Committee on Bioethics 1995; Spinetta et al 2003).…”

“…Known as shared decision making, this model is the guiding process in all physician-patient-parent interactions in health care (Committee on Bioethics 1995; Spinetta et al 2003). It requires adequate communication of medical information and options, while engaging all parties to contribute their views and identify values and preferences in order to reach a decision that is best aligned with the patient's best interest, parents' values and rights, and the child's wishes (Elwyn et al 2012;Fiks et al 2010;Gillam 2015;Whitney 2008;Whitney et al 2006).…”

The ethics of infant and early childhood mental health practice

“…The struggle of working through ethical challenges together is not something to be avoided, but something to be embraced. Indeed, the most ethically responsible approach is “to reflect, re‐think, acknowledge uncertainty and competing values, and sometimes even to agonise and struggle” (Gillam, 2015, p. 10). We hope that this article has illuminated some of the key concepts and principles in clinical ethics as they apply to IECMH practice and will stimulate a bigger conversation in the profession around how to support each other to maintain high ethical standards in our work with young children and their families.…”

Routine circumcision of infant boys: It's time to make progress through the common ground

“…It seems that the routine circumcision of infant boys is joining the ranks of the intractable. In a recent review of 50 years of paediatric ethics in Australia, Gillam notes that the ethical debate on infant male circumcision ‘…has seemingly gone round in circles rather than moving forward…’ . One only need Google ‘circumcision’ to see that it is now keeping company with issues like abortion and euthanasia by virtue of its thorniness and ability to polarise.…”

“…In a recent review of 50 years of paediatric ethics in Australia, Gillam notes that the ethical debate on infant male circumcision '…has seemingly gone round in circles rather than moving forward…'. 1 One only need Google 'circumcision' to see that it is now keeping company with issues like abortion and euthanasia by virtue of its thorniness and ability to polarise. At one end are the 'Intactivists', who maintain that the benefits of circumcision do not outweigh the risks and that a child's right to bodily integrity should be respected regardless of the beliefs of their parents.…”