Paediatrics: Recognition of ethical issues in everyday clinical practice

Recognition of ethical issues in everyday clinical practice

The key areas and issues that arise frequently in paediatric practice are summarized in Box 31.1.

Box 31.1 Key issues in paediatric practice

Consent

·  Age and Gillick/Fraser competence

·  Parental consent or refusal

·  Proxy consent

·  Refusal of treatment

·  Insistence on treatment

Best interests

·  Aggressive treatment

·  Resuscitation and do-not-resuscitate orders

·  Refusal of treatment by doctors

·  Cultural factors (e.g. circumcision, blood transfusion in Jehovah’s Witness)

Confidentiality

·  The doctor–patient relationship

·  Rights of minors with or without competence

·  Rights of the child versus the family

·  Rights of parents

Neonatal and paediatric intensive care

·  Resuscitation

·  Withholding and withdrawing treatment and end-of-life decisions

Child protection

·  Duties of the doctor and breaching confidentiality

Conflicts of interest: general practitioner’s duties to the family