5.5 Ethics in pediatric palliative care

Question 1

Children face certain challenges in health care settings due to their vulnerability. List four factors that contribute to vulnerability of a child in PC

Answer 1

youth (young age)
small physical size
illness
motor and cognitive impairment

Question 2

What are two paradigms that exist for the discussion of ethics in pediatric palliative care? What are the strengths and weaknesses of each?

Answer 2

Rights based arguments
-legalistic account on how physician should treat a child

Four principles approach - autonomy, beneficence, justice, non-maleficence

• not a single coherent theory but a practical heuristic for clinicians
• in ped PC autonomy is problematic (child does not clear autonomy), beneficence and non-maleficence do not consistently distinguish between interest of child or family and justice is complicated in a society composed mainly of adults

Question 3

Do children have autonomy? How does discussion of autonomy differ for children compared to adults?

Answer 3

Autonomy describes freedom to decide for oneself
Problematic in children as they are physically small, lack verbal skills etc
children often manifest autonomy by allowing parents to make decisions for them

autonomy is more limited for children than adults and must be respect in the relationship to their parent/guardian

Question 4

What is deontology? What is consequentialism? In what three ways does a utilitarian approach in medicine which seeks to maximize the sum of human happiness find difficulties?

Answer 4

a. Deontology - arguments flow from assumption that there is an absolute morality that is equally relevant to all people and in all situations irrespective of consequences
b. Consequentialism - only morally relevant aspect of an action is its consequences
c. the nature of happiness is not agreed on and may not measurable. In children happiness is hard to evaluate. does not acknowledge any relevance of intention

Question 5

What is the principle of double effect? What three aspects of undesirable outcomes need to be considered when discussion this principle ethically?

Answer 5

Acknowledgement of the possibility that physicians can foresee a range of outcomes from a single act

The proportionality of the outcome of the act
the probability of the outcome
The directness of the intention and the action that leads to a series of consequences that are increasingly remote from the agent intention

Question 6

When is it reasonable to withhold or withdraw life sustaining measures in a child?

Answer 6

for a child who is braindead or in a permanent or vegetative state
when the child’s best interests are served by not prolonging treatment
unbearable situation
no purpose situation