Ethics

Question 1

child’s affirmative agreement

Answer 1

child assent

dissent (disagreement)

Pediatric ethics requires clinicians and parents to override a child’s dissent when a proposed intervention is essential to his or her welfare. Otherwise, assent should be solicited and dissent should be honored.

Question 2

pediatric patients who may be able to provide informed consent ethically but not legally

Answer 2

older children and adolescents

they should be provided with the same information as would be given to an adult patient

Question 3

3 situations where a physician may oppose a pregnant woman’s refusal of an intervention

Answer 3

(1) the risk to the pregnant woman is minimal,
(2) the intervention is clearly effective, and
(3) the harm to the fetus without the intervention would be certain, substantial, and irrevocable

Question 4

The most serious ethical problem in health care in the USA

Answer 4

inequality in access to health care

Question 5

Mechanism that allows patients and/or appropriate surrogates to designate the desired medical interventions under applicable circumstances

Answer 5

Advanced directive

Question 6

Two key features of the “doctrine of double effect” (DDE) that must be present for actions to be ethically acceptable

Answer 6

1) the unintended outcome of the medication or withdrawal of treatment (i.e., respiratory depression; earlier death) should not be the means of achieving the intended outcome (relief of pain or other targeted symptoms); and
(2) intentionality is not a psychologic state, but an objective feature of the act itself (choice of medication, dose, timing, route of administration)