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Pediatric ethical dilemma

Pediatric ethical dilemma

Question

Using APA, write about 3 page paper on pediatric ethical dilemma. The pediatric ethical dilemma can be from a clinical experience or an article/story from the new. Example topics related to genetics/genomics issues include, but are not limited to: genetic testing, diagnosis of a genetic disorder, genetic counseling (or lack thereof), pharmacogenomics, lifelong surveillance, and recruiting individuals for genetics research.  Pediatric ethical dilemma

Pediatric Ethical Dilemma in Pediatric Nursing

Ethical dilemmas in nursing are some of the most challenging occurrences, as they involve a conflict between personal preservation and professional accountability. In pediatric nursing, ethical dilemmas offer unique challenges, as they involve minors and third parties, normally the parent or guardian of the child. Ethical dilemma in pediatrics arises mainly because the minor cannot make independent decision pertaining to treatment, a responsibility that is legally accorded to the guardian.  Additionally, medical situations such as separation of conjoined twins have considerable ethical implications.

An ethical dilemma I once read involved separation of conjoined twins in Massachusetts General Hospital in 2017. The conjoined twins aged 22 months and both girls had originated from Africa and were sharing several major organs, including liver and bladder (Malone, 2017). They were joined at the pelvis and abdomen. Surgical assessment in the hospital indicated that the separation process could only save the life one of them. However, failure to undertake the surgical separation would result to both of them dying.  In this case, the surgical team had to make a decision on which of the two to spare.  Eventually, the surgical operation was conducted and as expected, one of the twins died. The other survived and is reportedly to be doing well (Malone, 2017). In the scenario, various individuals were involved, including the parents of the conjoined twins, the multidisciplinary team of health experts involved in the process of surgical separation and the hospital’s ethical team.   The parents were the custodians and primary carers of the twins. The multidisciplinary team which included nurses, specialist surgeons and anesthetists were involved   in providing relevant interventions to the twins, before, during and after the surgical operation. The role of the hospital’s ethical committee was to assist the parents and healthcare professionals involved in the surgery make informed decision, by providing relevant information concerning the possible risks, and benefits of undertaking/failure to undertake the operation.Pediatric ethical dilemma

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Various ethical principles relate to the scenario presented. These include the principles of autonomy, nonmaleficence and beneficence (ANA, 2009). The principle of autonomy grants individual patients with the right to take part and make decisions in a medical process (Hester, 2008). Since they conjoined twins are minors, they could not provide a truly informed consent, and the parents had to make decisions on their behalf. The principle of nonmaleficence obligates healthcare professionals to do no harm (ANA, 2009). In the scenario, the surgical separation involved harming one conjoined twin but survival of the other. In this case, deciding to harm one twin for the benefit of the other was challenging. The principle of beneficence is based on promoting the goodness in others by refraining from doing harm (Fallat, & Glover, 2007).  In the scenario provided, undertaking the surgery was aimed promoting the goodness or wellbeing of the twins, because, failure to undertake the procedure would ultimately result to death of both.

During the time of care, it became apparent that separation of the twins through surgical operation was the only intervention that could promote health outcomes of one of them. Failure to separate them would result to both of them dying. However, each of the twins had equal right to life. And the parents had to make decisions on behalf of the twins. The surgical team had to consider the rights of the twins and the parents, and make decisions that would result to best possible outcome. Therefore, the hospital pediatric ethics committee took the initiative of informing parents about all possible outcomes that would come about from undertaking or failure to undertake the surgical separations of the twins. Eventually, the doctors went ahead with the surgery, in which the smaller and weaker of the twins died, but the other survived and recovered (Malone, 2017). To resolve the dilemma, the “standard of best interest”, whereby the healthcare professionals based their action on what they considered to be of best benefit to the twins was applied (Hester, 2008, p.8).  Pediatric ethical dilemma

To resolve the situation, the main resource applied was pediatric ethics committees to assist the patient and healthcare professionals in making informed decisions regarding dilemma in pediatrics. However, the main role of pediatrics ethics committee is to provide all relevant information to the parties involved, including all the possible adverse and beneficial outcomes that would occur after taking or failing to take a particular action.

References

American Nurses Association (ANA) (2009). Code of ethics for nurses and interpretative   statements. Silver Spring, Maryland; Author.

Fallat, M., & Glover, J.(2007). Professionalism in pediatrics. Pediatrics, 120(4):e1123–e1133.   doi: 10.1542/peds.2007-2230.

Hester, M.(2008). Pediatrics ethics: Why it deserves attention.  Pediatric Medicine and Bioethics,  3(4): 1-11.

Malone, S.( 2017, 26th June,). Conjoined twins posed ethical dilemma for Massachusetts hospital.  Accessed on 27 March 2018, from       https://www.aol.com/article/news/2017/10/26/conjoined-twins-posed-ethical-dilemma-for-massachusetts-hospital/23256641/ Pediatric ethical dilemma

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