Ethics

Question 1

The ethical principle of referring a child to an expert in the field or providing the best treatment available, considering treatment efficacy and potential to lessen disability

Answer 1

Beneficence (doing good for others or the best interest of the patient)

Question 2

The ethical principle of not ordering a head CT scan for a well-appearing child with trivial head injury or referring a child with obstructive sleep apnea secondary to enlarged tonsils and adenoids to ENT (weighing the risks and benefits in each case and avoiding possible complications)

Answer 2

Nonmaleficence (do no harm)

Question 3

The ethical principle of informing an adolescent about their diagnosis

Answer 3

Veracity (truthfulness or truth-telling)

Question 4

The ethical principle of maintaining the confidentiality of emancipated minor with STD

Answer 4

Fidelity, e.g., maintaining confidentiality or faithfulness

Question 5

The ethical principle of ideal distribution of risks and benefits, and resolving potential conflict

Answer 5

Justice, e.g., clinical research trials in children

Question 6

The ethical principle of ensuring access to medical care with federally sponsored child health insurance

Answer 6

Justice

Question 7

The ethical principle of autonomy of thought, intention, and action when making decisions regarding health care procedures or treatment

Answer 7

Autonomy

Question 8

Newborn with ambiguous genitalia. What is the best strategy in helping the parents consider the gender in which to rear the child?

Answer 8

A multidisciplinary team should give parents as much information as possible about their child’s diagnosis and prognosis

Question 9

Family desires to continue invasive therapy for child with irreversible and devastating neurological damage. The critical care physician and the neurologist strongly believe that there will be neither benefit nor quality of life for the child in continuing life support

Answer 9

Physicians are not obligated to provide futile care

Question 10

What is the best approach to the family in the previous example?

Answer 10

Physicians must provide families with relevant risks and benefits of available options and to provide specific recommendations

Question 11

Declaration of brain death requires

Answer 11

Two independent examinations, including a physical examination and apnea testing

Question 12

Following the agreement of parents or guardian for a child to participate in clinical research, at what age is consent of the child also required?

Answer 12

7years and older (unless cognitively impaired)

Question 13

A physician is receiving financial incentives for recruiting children to participate in a clinical drug trial

Answer 13

This practice is prohibited because of the potential element of undue influence and coercion

Question 14

What are the most critical criteria required to conduct a clinical drug trial in children?

Answer 14

Consent of guardians, child ≥7years, the best interests of the child, minimizing harm, safety committees, monitoring, meaningful and measurable outcomes

Question 15

How should the consent document for the clinical trial or research be written?

Answer 15

Easy to understand (sixth to eighth-grade reading level)

Question 16

A 4-year-old boy involved in a car accident requires a lifesaving blood transfusion. His adult parents refuse based on religious reasons. What should be done?

Answer 16

Transfuse the child (informed consent is not required to treat a child with a life-threatening condition)

Question 17

A 19-year-old involved in a car accident requires a lifesaving blood transfusion. Based on religious reasons he is refusing the blood transfusion. What should be done?

Answer 17

Respect the patient’s wishes and do not transfuse (patient is an adult)

Question 18

The process in which the risks and benefits along with potential alternatives are discussed with the parents before performing any procedure is known as

Answer 18

Informed consent—must be sought from the parents unless there is a life-threatening emergency and unable to contact them

Question 19

In what situation is a breach in confidentiality allowed, and parents or guardian must be notified about an adolescent’s medical condition?

Answer 19

Risk of harming self or others

Question 20

The mother of a 15-year-old female is here to obtain lab results that were ordered for obesity. The patient is unable to be present. What should you do?

Answer 20

Disclose the results to the mother (guardian)

Question 21

At what age is a minor considered developmentally mature and able to understand the consequences of his or her medical decision, and thus should be involved in making decisions about their medical care?

Answer 21

The beginning of 12–13years of age (mature minor doctrine)

Question 22

Parents have asked the pediatrician not to reveal a diagnosis to their adolescent because of the psychological impact. What is the best approach?

Answer 22

Arrange a meeting with parents and the adolescent to discuss the diagnosis and prognosis and provide psychological support if needed

Question 23

A 10-year-old girl recently diagnosed with a brain tumor; parents are asking you not to tell the child about her condition. What should be done in this situation?

Answer 23

Discuss the diagnosis and treatment with parents and the child (the child must know)

Question 24

What are the ethical principles in the previous 2 examples?

Answer 24

Veracity (truthfulness or being honest) and fidelity (faithfulness)

Question 25

A 15-year-old boy with terminal cancer has been hospitalized for 3months because of life- threatening complications and recurrent relapses. He decides to discontinue his medical care, and the family desires to continue treatment regardless of outcome. What is the best approach to the end-of life-care?

Answer 25

Medical team meeting with the child and family to elicit his preferences, inform him and his family about end-of-life decisions, improve communication, and increase agreement among all involved parties regarding end-of-life care

Question 26

A family with a well-known adult-onset genetic disorder (in the fifth to sixth decade) desires genetic testing for their children to know their future risks

Answer 26

No testing until the children reach adulthood (after 18years of age) when able to make an independent and informed decision

Question 27

Parents are new to your practice and refuse vaccinations to their children

Answer 27

Listen to parents and address all their concerns about vaccines
Explain all risks and benefits of the vaccines in question

Question 28

Parents continue to reject the vaccination to their children

Answer 28

Continue their care. Discuss risks and benefits in each subsequent visit

Question 29

If parents continue to refuse vaccinations for their child, is the pediatrician obligated to dismiss the child from his or her practice?

Answer 29

No. Pediatrician should continue care unless a strong sense of distrust develops that impacts a child’s overall care

Question 30

Parents brought their unimmunized 7-year-old boy who is bleeding from a raccoon bite. Parents refuse rabies vaccine

Answer 30

Report the family to state welfare agency (medical neglect)