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

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 8

Physicians are not obligated to provide futile
care

Question 9

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

Answer 9

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

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

7 years 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 ≥ 7 years, 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

What is the age of a minor to give consent for
screening of sexually transmitted infections,
consent for contraceptive services, and consent for general medical care?

Answer 16

Laws related to minor consent vary by state

Question 17

What is a minor called if the minor is married, in
the military, a parent, self-supporting while not
living with parents, or a high school graduate?

Answer 17

Emancipated minor (has the right to provide informed consent for medical care). The criteria
vary by jurisdiction

Question 17

At what age are contraceptive pills (progestin-only emergency contraceptive) available over the counter (OTC) to adolescents in all states in the USA?

Answer 17

17 years of age and older

Question 18

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 18

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

Question 19

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 19

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

Question 20

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 20

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

Question 20

A 16-year-old teenager requests confidential STD testing and pregnancy test. The mother comes without her child to demand the results of the pregnancy/STD testing. What should you do?

Answer 20

Do not disclose the results and protect patient
confidentiality

Question 21

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

Answer 21

Risk of harming self or others

Question 22

A 16-year-old teenager positive for gonorrhea is in the office with her 17-year-old boyfriend, who is waiting outside. She begs you not to tell him about her diagnosis. What should you do?

Answer 22

Do not tell the boyfriend, report her diagnosis to the CDC. Encourage her to inform him herself

Question 23

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 23

Disclose the results to the mother (guardian)

Question 24

You are seeing a 15-year-old female who says she has had consensual sexual activity with her
boyfriend who is 21 years old. What should be
done in this situation?

Answer 24

A report should be filed with child protective
services—the child is a minor (age may vary by
state) and the boyfriend is an adult

Question 25

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 25

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

Question 26

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 26

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

Question 27

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

Answer 27

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

Question 28

What are the ethical principles in the previous 2
examples?

Answer 28

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

Question 29

A 15-year-old boy with terminal cancer has been hospitalized for 3 months 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 29

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 30

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 30

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

Question 31

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

Answer 31

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

Question 32

Parents continue to reject the vaccination to their children

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

Report the family to state welfare agency
(medical neglect)