Ethical considerations in the management of analgesia in terminally ill pediatric patients.

Research has demonstrated the significant symptom burden present at the end of life of terminally ill children. Medicine has always viewed the relief of pain and suffering as a fundamental human right and a moral and ethical obligation. At the end of life, pain and dyspnea are symptoms commonly experienced by both adults and children. Opioids are the mainstay in treating the suffering associated with pain and dyspnea; however, there exist several barriers to the use of opioids. We describe a case in which parents prevent a young patient from receiving adequate pain management during the course of a terminal illness. We discuss the importance of recognizing the barriers to opioid use and the ethical ramifications of failing to find common ground with the family. We highlight parental responsibilities and limitations of parental authority in decision making for their child.

Conscience, clinical ethics, and emergency contraception.

Emergency contraception (EC) is a generic term used to describe a group of hormonal methods taken within the first few days after unprotected sexual intercourse to prevent an unintended pregnancy. EC is safe and effective in preventing pregnancy. Plan B or the generic levonorgestrel is available over-the-counter for women 17 years and older. A prescription is still required for women younger than 17 years of age. Even with its safety, effectiveness, and ease of accessibility for older adolescents and women, EC remains morally controversial. This article reviews the development of EC, presents data on the prevalence of conscientious objection, discusses how the change in status from prescription drug to over-the-counter medication has changed the debate, and makes recommendations for dealing with the controversies.

Pediatric emergency health care providers' knowledge, attitudes, and experiences regarding emergency contraception.

OBJECTIVES: The objective was to describe knowledge, attitudes, and experiences regarding emergency contraception (EC) among pediatric emergency health care providers (HCPs). METHODS: This multicenter, focus group study elicited thoughts and experiences from pediatric emergency HCPs about EC. Participants were physicians, nurse practitioners (NPs), and nurses in one of three urban, geographically distinct, pediatric emergency departments (EDs). A professional moderator used a semistructured format for sessions, which were audiotaped, transcribed, and analyzed for recurrent themes. Participants provided demographic information and completed a written survey evaluating EC knowledge. RESULTS: Eighty-five HCPs (41 physicians, eight NPs, and 36 nurses) participated in 12 focus groups. Overall knowledge about EC was poor. Participants identified barriers including cost, privacy, knowledge, and provider refusal. Provision of EC for adolescents was supported by the majority of physicians and NPs; however, many nurses were not supportive, especially following consensual intercourse. The authors identified use of social judgment by nurses as a novel barrier to EC provision. The majority of HCPs did not support screening for potential EC need. The majority of physicians and NPs felt obligated to provide adolescents with all contraceptive options, while more nurses supported provider refusal to provide EC. CONCLUSIONS: This study identified important HCP perceptions and barriers about EC provision in the pediatric ED. These findings may inform future efforts to improve EC provision for adolescents. Specifically, future studies to evaluate the differences in attitudes between nurses, physicians, and NPs, and the use of social judgment in EC provision, are warranted.