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Multiprofessional Critical Care Review: Pediatric ...
ediatric Ethics
ediatric Ethics
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Pdf Summary
Dr. H. Michael Ushay's discussion on ethical issues in pediatric critical care covers several critical aspects, including end-of-life considerations, surrogate decision-making, and the ethical principles guiding these decisions. The presentation outlines the core principles of bioethics—autonomy, beneficence, non-maleficence, and justice—and their application in pediatric care. Notably, the principle of substituted judgment, typically used for patients who were once competent, isn't as common for pediatric and developmentally disabled populations. Instead, decisions are often made based on the best interests of the patient, considering the harm threshold and utilizing shared, family-centered decision-making approaches.<br /><br />Another significant point is the Doctrine of Double Effect, which allows for ethically permissible actions that may hasten death if the primary intention is to alleviate severe pain and not to cause death. This doctrine becomes relevant in cases involving the use of pain medications that might inadvertently shorten a child's life.<br /><br />When discussing paralytic agents, Dr. Ushay emphasizes the necessity to avoid these during the dying process unless the patient has already been receiving them or waiting for their effects to subside would cause undue delay. Ethical decision-making in such scenarios also considers the balance between parental autonomy and the child's well-being, suggesting constraints on parental decisions that might not meet the child's basic health needs.<br /><br />Consent and competence are vital elements in pediatric care, with children generally considered legally incompetent until they reach 18 or 21. Exceptions exist for emancipated minors and those deemed mature by judicial decision. The presentation outlines the conditions under which minors can consent to their own health care, emphasizing developmental and intellectual capacities.<br /><br />Cases presented in the slides exemplify these ethical principles in real-life dilemmas, illustrating the complexity and nuances in making ethical decisions in pediatric critical care. The slides also touch upon the ethical challenges brought by the COVID-19 pandemic, particularly in resource allocation.<br /><br />In summary, Dr. Ushay's presentation provides a comprehensive overview of the ethical considerations in pediatric critical care, highlighting the importance of ethical principles, surrogate decision-making, and patient-centered care.
Keywords
pediatric critical care
ethical issues
end-of-life
surrogate decision-making
bioethics principles
substituted judgment
Doctrine of Double Effect
parental autonomy
consent and competence
COVID-19 resource allocation
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