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Pediatric bioethics

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https://www.readbyqxmd.com/read/29111941/reasons-to-amplify-the-role-of-parental-permission-in-pediatric-treatment
#1
Mark Christopher Navin, Jason Adam Wasserman
Two new documents from the Committee on Bioethics of the American Academy of Pediatrics (AAP) expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the importance of informed and voluntary parental involvement in pediatric decision making...
November 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/28945637/serum-hepcidin-in-children-with-inflammatory-bowel-disease
#2
Paulina Krawiec, Agnieszka Mroczkowska-Juchkiewicz, Elżbieta Pac-Kożuchowska
BACKGROUND: Hepcidin is a major regulator of iron homeostasis and a mediator of innate immunity. To date, the role of hepcidin in inflammatory bowel disease (IBD) children is not clearly established. We aimed to assess serum hepcidin concentration in IBD children and correlate hepcidin with iron status parameters and inflammatory markers. METHODS: The study group included 46 pediatric patients with ulcerative colitis and 29 with Crohn's disease. In control group, there were 21 children with functional gastrointestinal disorders...
December 2017: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/28759411/controversy-about-dialysis-for-an-adolescent
#3
Tyler Tate, Aviva Goldberg, Aaron Wightman, Bradley A Warady, John D Lantos
For patients on dialysis, 1 frequent cause of death is their voluntary decision to discontinue dialysis. Such decisions raise complex questions when the patient is a competent adult. The decisions are even more complex when the patient is an adolescent. In this article, we present a case in which a 17-year-old adolescent decided that she no longer wished to undergo dialysis through her fistula. Her doctors thought that dialysis using any other technique would be too dangerous. Four experts in pediatric nephrology, bioethics, and palliative care discuss this decision and the different ways that the health care team might respond...
July 2017: Pediatrics
https://www.readbyqxmd.com/read/28638969/introduction-childhood-and-disability
#4
EDITORIAL
Erica K Salter
From growth attenuation therapy for severely developmentally disabled children to the post-natal management of infants with trisomy 13 and 18, pediatric treatment decisions regularly involve assessments of the probability and severity of a child's disability. Because these decisions are almost always made by surrogate decision-makers (parents and caregivers) and because these decision-makers must often make decisions based on both prognostic guesses and potentially biased quality of life judgments, they are among the most ethically complex in pediatric care...
June 21, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28577266/reimagining-childhood-responding-to-the-challenge-presented-by-severe-developmental-disability
#5
Erica K Salter
Through an exploration of the experience of severe and profound intellectual disability, this essay will attempt to expose the predominant, yet usually obscured, medical anthropology of the child and examine its effects on pediatric bioethics. I will argue that both modern western society and modern western medicine do, actually, have a robust notion of the child, a notion which can find its roots in three influential thinkers: Aristotle, Immanuel Kant and Jean Piaget. Together, these philosophers offer us a compelling vision: the child is primarily a future rational, autonomous adult...
June 2, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28376068/parents-perspective-on-trainees-performing-invasive-procedures-a-qualitative-evaluation
#6
Madeline L McCarthy, Lindsey T Chaudoin, Mark R Mercurio, Elizabeth G J O'Brien, Sweta Bhargava, Sarah Y Cohen, Marc Auerbach, Gunjan Tiyyagura
OBJECTIVES: When obtaining informed permission from parents for invasive procedures, trainees and supervisors often do not disclose information about the trainee's level of experience. The objectives of this study were 3-fold: (1) to assess parents' understanding of both academic medical training and the role of the trainee and the supervisor, (2) to explore parents' preferences about transparency related to a trainee's experience, and (3) to examine parents' willingness to allow trainees to perform invasive procedures...
April 4, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28326208/a-child-as-a-donor-for-hematopoietic-stem-cell-transplantation-bioethical-justification-a-case-study-on-sickle-cell-disease
#7
Andrea Z Pereira, Ricardo Hellman, Nelson Hamerschlak, Andrea Kondo, Polianna Mara Rodrigues de Souza, Wilson Leite Pedreira, Luiz Fernando Alves Lima Mantovani, Eduardo Juan Troster, Henrique Grunspun, Marco Aurélio Scarpinella Bueno
Hematopoietic stem cell transplantation (HSCT) is an important treatment option for children with severe and refractory sickle cell disease (SCD) with debilitating clinical complications. HSCT with cells from the bone marrow of a HLA-identical sibling used in SCD has a low mortality risk, high cure rate, and high event-free survival rate after a median follow-up of 5-6 years. However, matched donors are found in only about 20% of the patients. A boy aged 8 years with SCD had a sister, <2 years old, a fully compatible donor...
2017: Case Reports in Hematology
https://www.readbyqxmd.com/read/28238481/attitudes-and-counseling-practices-of-pediatricians-regarding-youth-sports-participation-and-concussion-risks
#8
Michael Fishman, Eleanor Taranto, Meryl Perlman, Kyran Quinlan, Holly J Benjamin, Lainie Friedman Ross
OBJECTIVE: To examine attitudes and practices of pediatricians toward sports-related head trauma and youth participation in tackle football and ice hockey. STUDY DESIGN: A respondent-anonymous electronic survey was distributed 3 times to members of the American Academy of Pediatrics Section of Bioethics, Council on Injury, Violence, and Poison Prevention, and Council on Sports Medicine and Fitness. RESULTS: Of 791 eligible pediatricians, 227 (29%) responded...
May 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28225696/what-to-do-when-there-aren-t-enough-beds-in-the-picu
#9
Michael A Rubin, Robert D Truog
The concepts of medical futility and rationing are often misunderstood and lead to significant consternation when resources are stretched and pediatric intensive care unit (PICU) beds are unavailable. While the two concepts overlap, each has its own distinct application and moral justification. Most importantly, we should avoid using one to justify the other. Bioethics professionals should assist critical care clinicians in clarifying when each rubric should be applied as well as how to develop policies to standardize the approach...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28076529/relationships-between-oncohematopediatrics-mothers-and-children-in-communicating-bad-news
#10
Selene Beviláqua Chaves Afonso, Maria Cecília de Souza Minayo
We present a study about the relations between pediatric oncological haematologists, mothers, and children in sharing bad news (BN) in a public hospital in Rio de Janeiro. The text emphasizes the intertwining of technique and emotions for the treatment of children with diagnoses in which the fatal outcome is always a probability. We used a qualitative approach, privileging participant observation and open interviews with oncologists (at this service all professionals were female) and mothers. We sought to understand the importance of communication which includes expressions and control of emotions; bioethical issues that require sensitivity, serenity, and truth about approaching the end of life; and how the professionals balance proximity to children and families and objectivity in their activity...
January 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28025237/responsible-innovation-in-children-s-surgical-care
#11
REVIEW
(no author information available yet)
Advances in medical care may occur when a change in practice incorporates a new treatment or methodology. In surgery, this may involve the translation of a completely novel concept into a new procedure or device or the adaptation of existing treatment approaches or technology to a new clinical application. Regardless of the specifics, innovation should have, as its primary goal, the enhancement of care leading to improved outcomes from the patient's perspective. This policy statement examines innovation as it pertains to surgical care, focusing on some of the definitions that help differentiate applied innovation or innovative therapy from research...
January 2017: Pediatrics
https://www.readbyqxmd.com/read/27612155/prenatal-effects-of-zika-virus-and-management-of-the-pregnant-woman
#12
REVIEW
Solange N Eloundou, Jeanne S Sheffield
The identification of Zika virus as a significant teratogen has raised international concern, causing the World Health Organization to declare a Public Health Emergency of International Concern. This has allowed a global mobilization of experts in tropical infectious diseases, obstetrics, pediatrics, virology, public health policy, reproductive health, bioethics, and germ cell research to name just a few. This worldwide crisis has also raised awareness of health care disparities and concerns regarding the ability of families and societies to shoulder the long-term financial burden that the follow-up of affected children will require...
September 2016: Seminars in Reproductive Medicine
https://www.readbyqxmd.com/read/27586522/the-ethics-of-vaccination-nudges-in-pediatric-practice
#13
Mark C Navin
Techniques from behavioral economics-nudges-may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate...
March 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/27462957/exhaust-all-measures-ethical-issues-in-pediatric-end-of-life-care
#14
Kara J Thieleman, Cara Wallace, Andrea N Cimino, Heidi A Rueda
The death of a child may have a profound impact on parents, family members, and health care providers who provided care for the child. Unique challenges are faced by parents of seriously ill children as they must serve as the legal authority for health care decisions of children under age 18, although the child's wishes must also be considered. Social workers must balance core social work values, bioethical values, and psychosocial issues presented by such situations. While studies have been conducted with physicians and nurses regarding ethical issues in pediatric end-of-life care settings, little is known about how social workers experience these conflicts...
July 2016: Journal of Social Work in End-of-life & Palliative Care
https://www.readbyqxmd.com/read/27461194/developing-a-bioethics-curriculum-for-medical-students-from-divergent-geo-political-regions
#15
Rebecca A Greenberg, Celine Kim, Helen Stolte, Jonathan Hellmann, Randi Zlotnik Shaul, Rahim Valani, Dennis Scolnik
BACKGROUND: The World Health Organization calls for stronger cross-cultural emphasis in medical training. Bioethics education can build such competencies as it involves the conscious exploration and application of values and principles. The International Pediatric Emergency Medicine Elective (IPEME), a novel global health elective, brings together 12 medical students from Canada and the Middle East for a 4-week, living and studying experience. It is based at a Canadian children's hospital and, since its creation in 2004, ethics has informally been part of its curriculum...
July 27, 2016: BMC Medical Education
https://www.readbyqxmd.com/read/27456514/informed-consent-in-decision-making-in-pediatric-practice
#16
COMMENT
(no author information available yet)
Informed consent should be seen as an essential part of health care practice; parental permission and childhood assent is an active process that engages patients, both adults and children, in health care. Pediatric practice is unique in that developmental maturation allows, over time, for increasing inclusion of the child's and adolescent's opinion in medical decision-making in clinical practice and research.
August 2016: Pediatrics
https://www.readbyqxmd.com/read/27456510/informed-consent-in-decision-making-in-pediatric-practice
#17
Aviva L Katz, Sally A Webb
Informed consent should be seen as an essential part of health care practice; parental permission and childhood assent is an active process that engages patients, both adults and children, in their health care. Pediatric practice is unique in that developmental maturation allows, over time, for increasing inclusion of the child's and adolescent's opinion in medical decision-making in clinical practice and research. This technical report, which accompanies the policy statement "Informed Consent in Decision-Making in Pediatric Practice" was written to provide a broader background on the nature of informed consent, surrogate decision-making in pediatric practice, information on child and adolescent decision-making, and special issues in adolescent informed consent, assent, and refusal...
August 2016: Pediatrics
https://www.readbyqxmd.com/read/27426893/vincent-a-fulginiti-md-1931-2013-a-visionary-leader-in-pediatric-education-research-and-bioethics
#18
REVIEW
Laura C Fulginiti, Grant Morrow, Elmer S Lightner
No abstract text is available yet for this article.
August 2016: Advances in Pediatrics
https://www.readbyqxmd.com/read/27346825/a-life-below-the-threshold-examining-conflict-between-ethical-principles-and-parental-values-in-neonatal-treatment-decision-making
#19
Thomas V Cunningham
Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision-making are the harm principle, the principle of best interest, and the threshold view. This paper considers how these principles apply to a case of a premature neonate with multiple significant co-morbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help in understanding what was morally right for the child is questioned...
2016: Narrative Inquiry in Bioethics
https://www.readbyqxmd.com/read/27253891/three-decades-after-baby-doe-how-neonatologists-and-bioethicists-conceptualize-the-best-interests-standard
#20
F X Placencia, Y Ahmadi, L B McCullough
OBJECTIVE: The objective of this study is to determine how neonatologists and bioethicists conceptualize and apply the Best Interests Standard (BIS). STUDY DESIGN: Members of the American Society for Bioethics and Humanities and the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine were surveyed to determine how they conceptualized the BIS and ranked the appropriateness of forgoing life-sustaining therapy (LST). RESULTS: Neonatologists' median response supported an infant-specific BIS conceptualization that linked the infant's and family's interests...
October 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
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