Caring for a critically ill or severely injured person is clinically demanding, ethically challenging, and often stressful. When that person is a child, the demands, challenges, and likelihood of stress are compounded. This month’s authors explain the rigorous ethical consideration that must be given to treatment decisions that cannot be made by the patients themselves. Beyond treatment, how should needed research on interventions for critically ill children be carried out ethically, and how can pediatric residents be trained in life-saving procedures so that their skills are honed and ready when they are needed?
However good the intentions, calling a slow code to protect an infant from futile, aggressive treatment raises significant ethical questions about deceit, paternalism, patient-doctor relationships, and teaching good communication skills.
Research in the PED and PICU is essential to medical understanding of the efficacy of emergency interventions. Researchers must minimize the additional stress that consent and participation in research entail for pediatric patients and their families.
Preventing bad outcomes for teens and their offspring was the impetus behind confidential care for reproductive health. Requiring parental involvement created an obstacle to the provision of necessary care.