Cognitive enhancement in children and adolescents: is it in their best interests?

UNLABELLED: Evidence suggests children and adolescents are consuming stimulants and nonstimulants in the hopes of improving academic performance through cognitive enhancement. As such, clinicians may be faced with requests to prescribe enhancers for their paediatric patients. In this article, we analyse the ethics of cognitive enhancement in paediatrics in the light of the best interests standard, a guiding principle, often used to make decisions for minors in moral, legal, social and medical contexts. CONCLUSION: Cognitive enhancement in children and adolescents does not represent an ethical ideal that societies should strive for. Furthermore, paediatric cognitive enhancement does not meet the criteria for a minimally acceptable practice, given the health-related risks posed by these medications and the coercive environments such a practice creates. In line with a recent policy statement by the American Academy of Neurology, ethical and clinical arguments based on the best interests of paediatric patients encourage clinicians to refrain from engaging in this practice.

[Palliative care birth plan: a field of perinatal medicine to build]. / Projets de naissance en soins palliatifs : un domaine de la périnatalité à construire.

Some couples may choose to continue the pregnancy unable to decide for termination of pregnancy. Such situations recently occurred in neonatology units and may lead to neonatal palliative care. Faced with all uncertainties inherent to medicine and the future of the baby, medical teams must inform parents of different possible outcome step by step. Consistency in the reflection and intentionality of the care is essential among all different stakeholders within the same health team to facilitate support of parents up to a possible fatal outcome. This issue in perinatal medicine seems to be to explore how caregivers can contribute in the construction of parenthood in a context of a palliative care birth plan.

[Decision-making in termination of pregnancy: a French perspective]. / Décision d'interruption médicale de grossesse : le point de vue des soignants français.

OBJECTIVE: To evaluate the caregivers' opinions regarding decision-making in termination of pregnancy (TOP) for fetal anomaly. MATERIAL AND METHODS: Questionnaire survey using a semi-structured survey based on visual analogue scales, sent to all multidisciplinary centres for prenatal diagnosis in France. Answers were received from 26 centres nation-wide. RESULTS: Response rate was 39% (213 responses received over 550 questionnaires sent). Fifty-five percent of respondents were women, 90% physicians, 7,5% midwives. A vast majority (69.8%) believes that their own convictions play a bigger role in decision in real practice than in their ideal. The major decisional factors in decision-making for TOP are: the long-term prognosis of the anomaly, a specialized opinion on its curability, the quality of the information given to the future parents, their expressed opinion, the existence of a multidisciplinary decision, the ability of the future parents to understand the medical data, the obtention of a medical consensus, the proof level of the medical information. For only 55% of the respondents, the current legal framework is adequate to manage the situations that result from prenatal diagnostic practices today. The question of late third-trimester TOP raises ethical debate: over a third (37%) see no ethical difference between TOP and withdrawal of care during the neonatal period; the majority (48% versus 43%) feel that ethically speaking a neonate and a foetus at 39 weeks gestational age (GA) should not be treated differently; 37% of the respondents feel that current practice is likely to lead to eugenism. DISCUSSION AND CONCLUSION: As far as TOP is concerned, the huge discrepancies in responses from the professionals highlight the ongoing ethical debate, especially concerning the concept of informed choice in TOP, which we believe should be entirely revisited.

Hospital stay and short-term follow-up of children of drug-abusing mothers born in an urban community hospital--a retrospective review.

UNLABELLED: In order to assess the current use of medical and social services of children of drug-abusing mothers in regard to their short term outcome in a Swiss urban community hospital, we compared hospital, private paediatricians and home nursing records of 37 of these children with 37 matched control children from birth to 18 months of age. Children of drug-abusing mothers (CDAM) experienced a longer neonatal hospital stay than control children with a median (25%-75%) of 26 days (10.5-52.5 days) versus 5 (5-6) days (P < 0.001), a substantial part of which, 8 days (3.5-26 days) versus 0 days (0-1 day) (P < 0.001) was not motivated by any specific medical treatment or nursing care. Before discharge, CDAM were referred to out of hospital nursing and social services for further management, but only 13% were effectively followed. More than 50% were lost to follow-up by their initial paediatrician after 1 year of life. CONCLUSION: New ways to ensure better co-ordination between paediatricians and the social services (inside and outside the hospital) should be developed to shorten the neonatal hospitalisation period and improve the quality of follow-up.