Ethical Dilemmas in Pediatrics: Cases and Commentaries

by Edited by Lorry R. Frankel , Amnon Goldworth , Mary V. Rorty , William A. Silverman

• ISBN13: 9780521847445
• ISBN10: 0521847443
• Format: Hardcover
• Copyright: 2005-07-11
• Publisher: Cambridge University Press

Summary

Children in precarious health present particular problems for health-care professionals because of their intimate relation to their family, and because of the family's need to provide major long-term source of support and to be actively involved in the decisions about their children's care. This collection of cases and commentaries in pediatrics highlights the difficult ethical dilemmas that can arise during high-tech hospital care of children in precarious circumstances. It serves as a teaching tool for clinical ethics and as an introduction for medical students and residents. Clinical cases are described in detail by the physicians involved, who focus on the ethical issues arising during treatment. Each case is then commented on in detail by a philosopher or other bioethicist. It thus serves well as an introduction to contemporary clinical bioethics, but with a firm grounding in the practicalities of real-life pediatric care in the hospital setting.

Table of Contents

List of contributors	viii
Preface	xi
Introduction	1	(12)
Part I Therapeutic misalliances
Unconventional medicine in the pediatric intensive care unit	13	(8)
Chester J. Randle Jr.
Role responsibility in pediatrics: appeasing or transforming parental demands?	21	(9)
Richard B. Miller
Topical discussion	30	(4)
The extremely premature infant at the crossroads	34	(3)
Ronald Cohen
Eugene Kim
The extremely premature infant at the crossroads: ethical and legal considerations	37	(15)
Simon N. Whitney
Topical discussion	52	(3)
Munchausen syndrome by proxy	55	(12)
Manuel Garcia-Careaga
John A. Kerner Jr.
Some conceptual and ethical issues in Munchausen syndrome by proxy	67	(13)
Frances M. Kamm
Topical discussion	80	(9)
Part II Medical futility
Letting go: a study in pediatric life-and-death decision making	89	(6)
Lawrence H. Mathers
Near-drowning, futility, and the limits of shared decision making	95	(13)
Simon N. Whitney
Topical discussion	108	(5)
Long-term ventilation in a child with severe central nervous system impairment	113	(6)
Ronald M. Perkin
Robert Orr
Stephen Ashwal
Autonomy, community, and futility: moral paradigms for the long-term ventilation of a severely impaired child	119	(12)
Anita Silvers
Topical discussion	131	(4)
Complexities in the management of a brain-dead child	135	(5)
Lorry R. Frankel
Chester J. Randle Jr.
The moral arena in the management of a brain-dead child	140	(8)
Amnon Goldworth
Topical discussion	148	(9)
Part III Life by any means
Where should a child die?	157	(5)
Roger Burne
Where should a child (in the USA) die?	162	(4)
William A. Silverman
Topical discussion	166	(4)
Infant heart transplantation and hypoplastic left heart syndrome: what are the ethical issues?	170	(7)
Clifford Chin
Infant heart transplantation and hypoplastic left heart syndrome: a response	177	(8)
Joel E. Frader
Topical discussion	185	(5)
Liver and intestinal transplantation	190	(6)
Manuel Garcia-Careaga
Ricardo Orlando Castillo
John A. Kerner Jr.
Transplantation and adolescents	196	(16)
Rosamond Rhodes
Topical discussion	212	(9)
Part IV Institutional impediments to ethical action
Ethical problems encountered with oncology and bone marrow transplant patients	221	(8)
Lorry R. Frankel
Joseph V. DiCarlo
Ethics in the pediatric intensive care unit: oncology and bone marrow transplant patients	229	(7)
Linda Granowetter
Topical discussion	236	(3)
Nursing perspectives on withholding food and fluids in pediatrics	239	(7)
Joy Penticuff
Ethics and clinical decision making: withholding food and information	246	(7)
Mary V. Rorty
Topical discussion	253	(4)
Ethics and managed care	257	(10)
Douglas S. Diekema
Challenging fidelity: the physician's role in rationing	267	(10)
Nancy S. Jecker
Topical discussion	277	(5)
References	282	(14)
Index	296