Ethical considerations in pediatric surgery

Abstract

Pediatric surgeons are often confronted with clinical situations that involve decisions about the continuation of life-sustaining treatments for infants and children with critical illness. These diffi cult issues fall within the basic social commitment that defines the professional obligation of physicians to sustain life and relieve suffering. Ethics is the philosophic discipline concerned with questions of right and wrong. Medical ethics, also known as bioethics, outlines the standards, principles, and rules of conduct that govern physician behavior and the practice of medicine. It also seeks to inform and guide the resolution of moral dilemmas as they arise in patient care and within the broad context of societal healthcare. Four major principles have been elucidated in medical ethics: benefi cence, which exhorts physicians to do or promote good; nonmalefi cence, which cautions physicians to do no harm; autonomy, which respects the right of competent persons to give informed consent for medical treatment and have control over their bodies; and justice, which involves the fair and equitable distribution of medical care to all persons. These principles focus on the action or actions that give rise to dilemmas, such as withdrawing life-sustaining treatment from a terminally ill patient. In contrast, virtue ethics emphasizes the agents (physicians) and the recipients (patients) of principle-based actions and decisions. It espouses several virtues that are necessary for the delivery of good medical care, and is particularly relevant to the practice of pediatric surgery. These virtues include fi delity to trust, compassion, phronesis or common sense, fortitude, integrity, honesty, and self-effacement. © 2009 Springer Berlin Heidelberg.