Ethical principles in paediatric practice

Abstract

Clinical problems with significant ethical implications pose an ever increasing dilemma in everyday medical practice in the 21st century and rarely present a simple solution. This is particularly the case with ethical issues involving children and those unable to take their own decisions. Whilst the patients’ interests should come first and all personal, cultural and religious bias eliminated, the impact of costly treatment for the individual patient on the available healthcare resources must also be taken into account. Hence, it is essential to establish an ethically acceptable code of practice which will allow doctors to provide an objective approach to management that is rational and consistent, both for the patient as well as society at large regardless of creed or culture. An equally important code of practice is required for medical research, whether this involves clinical trials on children, laboratory and animal studies. Although the same general principles are applied to guide all medical ethical problems, these may be adjusted to different research scenarios. Particularly difficult issues relate to research involving subjects who are unable to fully comprehend the ethical issues at stake, especially the embryo, children and those with a disability, as well as issues relating to the initiation of intensive care or ‘extraordinary’ measures and, finally, issues relating to the discontinuation of care and the dying process.