Chapter 28: ETHICS IN PEDIATRICS

Like any area of medicine, ethics can be complicated. The good news is that you only need to know some basic principles and terms in order to get most of the questions correct. For the purposes of studying for the boards, DO NOT waste time studying and thinking about difficult ethical problems and edge cases. Instead, just focus on the basics that are found in this chapter, and focus on other chapters that are much higher yield. Although these are the types of questions that most test-takers stress about, they usually only comprise about 1% of the exam.

MAIN PRINCIPLES AND TERMS

• Autonomy
• Beneficence
• Rights
• Consent
• Permission
• Assent

AUTONOMY

One of the foundations of medical ethics is autonomy, a person’s right to make his own decisions. When it comes to medical issues, this right is nearly absolute for someone who is competent, able to understand the issues, and make decisions rationally. That person can be treated only with his or her consent, and is free to refuse even life-saving treatment.

People may be considered not competent if they are mentally ill, intoxicated, demented, or otherwise unable to understand their situation and make rational decisions.

More importantly for pediatricians, children do not have this complete autonomy. Minors are given limited autonomy when it comes to issues of reproductive and mental health. So, if you get a question about whether or not you can have a private visit with an adolescent for pregnancy, contraception, depression or STD treatment without parental consent, the answer is YES.

Emancipated minors are under 18, but legally function as adults and able to give medical consent. Marriage (state dependent), having a child, living independently, or being in the military typically qualify a minor as emancipated.

Non-emancipated minors < 18 years old and consent for procedures: For emergencies, there is implied consent and the procedure may move forward. If it’s not an emergency, then a non-emancipated minor needs parental consent.

Once a child turns 18 years old, he/she can make her own medical decisions (slight variation on a state-by-state basis).

BENEFICENCE

Beneficence (“doing good”) is the principle that the physician must act for the benefit or well-being of the patient. The patient’s interest always comes first.

PEARL: When evaluating answer choices, always ask yourself, “Which answer is in the best interest of the patient.”