RESUMEN
This Viewpoint explains the role of child abuse pediatricians and makes specific recommendations for communicating their role in medical care.
Asunto(s)
Maltrato a los Niños , Pediatras , Humanos , Maltrato a los Niños/ética , Maltrato a los Niños/prevención & control , Niño , Pediatras/ética , Revelación/ética , Relaciones Médico-Paciente/ética , Pediatría/éticaAsunto(s)
COVID-19 , Relaciones Interprofesionales , Pediatras , Rol del Médico , Medios de Comunicación Sociales , COVID-19/diagnóstico , COVID-19/terapia , Humanos , Relaciones Interprofesionales/ética , Pediatras/ética , Pediatras/psicología , Rol del Médico/psicología , Profesionalismo , Medios de Comunicación Sociales/éticaAsunto(s)
Equidad en Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Personas Intersexuales/psicología , Minorías Sexuales y de Género/psicología , Adolescente , Concienciación , Niño , Depresión/epidemiología , Identidad de Género , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Servicios de Salud Mental/tendencias , Nombres , Pediatras/ética , Sexismo/psicología , Sexismo/estadística & datos numéricos , Conducta Sexual/psicología , Ideación SuicidaRESUMEN
Increasing use of social media by patients and clinicians creates opportunities as well as dilemmas for pediatricians, who must recognize the inherent ethical and legal complexity of these communication platforms and maintain professionalism in all contexts. Social media can be a useful tool in the practice of medicine by educating both physicians and patients, expanding access to health care, identifying high-risk behaviors, contributing to research, promoting networking and online support, enhancing advocacy, and nurturing professional compassion. At the same time, there are confidentiality, privacy, professionalism, and boundary issues that need to be considered whenever potential interactions occur between physicians and patients via social media. This clinical report is designed to assist pediatricians in identifying and navigating ethical issues to harness the opportunities and avoid the pitfalls of social media.
Asunto(s)
Pediatras/ética , Profesionalismo/ética , Medios de Comunicación Sociales/ética , Confidencialidad , Conflicto de Intereses , Empatía , Empoderamiento , Humanos , Relaciones Interpersonales , Defensa del Paciente , Educación del Paciente como Asunto , Participación del Paciente , Pediatras/educación , Relaciones Médico-Paciente , Privacidad , Investigación , Asunción de Riesgos , AutorrevelaciónAsunto(s)
Asma/tratamiento farmacológico , Pediatras/ética , Médicos/normas , Asma/diagnóstico , Broncodilatadores/administración & dosificación , Broncodilatadores/uso terapéutico , Preescolar , Continuidad de la Atención al Paciente/ética , Toma de Decisiones/ética , Epinefrina/administración & dosificación , Epinefrina/uso terapéutico , Femenino , Humanos , Acontecimientos que Cambian la Vida , Padres , Pediatras/educación , Pediatras/psicología , Apoyo SocialRESUMEN
En los últimos años el número de divorcios ha ido aumentando, siendo en ocasiones, para el paciente pediátrico, el divorcio de sus padres un elemento traumático. Nuestro objetivo fue analizar los conflictos éticos que se producen en la relación sanitaria médico-padres-hijo y de forma más específica en niños procedentes de separación/divorcio. Se realizó un estudio descriptivo mediante una encuesta compuesta de 39 items. Previamente se realizó un análisis bibliográfico exhaustivo de artículos relacionados. Nuestros resultados muestran que solo el 35% de los pediatras ha recibido formación en bioética pese a su importancia en la práctica diaria. Sobre otras cuestiones, la mayoría (57,5%) no retiraría el tratamiento de un paciente enfermo pese a que aumentara su calidad de vida, y actuaría ante una decisión equivocada de los padres (82,5%). Dan poco valor a las decisiones del menor (6,05%), raramente informados exclusivamente (5%). En cambio, se les informa primero en un 20% de los casos y en el 90% se les implica. Respecto a los progenitores, el 17,5% de las madres son informadas en exclusiva, nunca los padres. La ética tiene un valor intrínseco muy importante en las decisiones clínicas habituales, respetándose generalmente las normas y adaptándose a la situación particular de cada niño/a. En los casos en los que hay un conflicto importante, como divorcios, es importante conocer a quién se debe informar, y qué derecho tiene cada uno a decidir. Aún resulta difícil para algunos pediatras aplicar la ley 41/2002 de Autonomía del Paciente
Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never hap-pens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Relaciones Médico-Paciente/ética , Menores , Divorcio/ética , Custodia del Niño/ética , Relaciones Padres-Hijo , Pediatras/ética , Autonomía Personal , Derechos del Paciente/ética , Encuestas y Cuestionarios , Conocimientos, Actitudes y Práctica en Salud , Pautas de la Práctica en MedicinaRESUMEN
In this issue of The Journal of Clinical Ethics, Professor Ruth Tallman argues that pediatricians ought to support adolescent football players in their athletic goals. She does not deny that doing so means "helping children hurt themselves"; rather she argues that this would be consistent with a shared decision-making model in which both the physician and the patient seek to promote the patient's well-being in light of the patient's own goals. I argue that this ignores the role of the parents, meaning that Tallman is suggesting "helping parents allow their children to hurt themselves." As a general pediatrician, I would classify this as child neglect, if not downright child abuse. I argue that pediatricians should counsel directively against youth tackle football, employ a deliberative approach to shared decision making within the triadic doctor-patient-parent relationship, and support youth sport policies that seek to reduce traumatic brain injury by advocating for flag football, by prohibiting checking in boys' ice hockey, and by minimizing heading the ball in soccer below a certain age.
Asunto(s)
Traumatismos en Atletas , Consejo Dirigido , Obligaciones Morales , Pediatras , Pediatría , Deportes Juveniles , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Traumatismos en Atletas/prevención & control , Conmoción Encefálica/prevención & control , Consejo Dirigido/ética , Fútbol Americano , Pediatras/éticaRESUMEN
It has been demonstrated by statistics that COVID-19 pandemic has not been as aggressive among pediatric population as in adults. Yet, pediatricians and the rest of the health care team face the dilemma of keeping the commitment and responsibilities towards the patients or withstanding the uncertainties arising versus the possibilities of getting infected and spreading it to their beloved ones. There are two main issues: during the professional everyday practice, is there a moral limit when it comes to taking risks? And what is the importance of having difficulty in getting the proper safety equipment in order to decrease the potential risks? Bioethics, as we think, may work as a tool, helping us all to ponder this and the many other bearings we are facing with the current pandemic.
Las estadísticas arrojadas por la pandemia de COVID-19 evidencian que el impacto sobre la población pediátrica no ha tenido la magnitud mostrada en los adultos. Aun así, tanto para los pediatras como para el resto de los integrantes de los equipos de salud, se plantea un dilema entre el mantenimiento de la responsabilidad, el compromiso en la atención de los pacientes afectados y las dudas e incertidumbres surgidas frente a la posibilidad de contraer la enfermedad y de trasmitirla a los seres más cercanos. Desde allí, se estructuran dos cuestiones centrales: ¿existe un límite moral frente a la posibilidad de correr riesgos durante el ejercicio profesional?, ¿qué influencia tiene la dificultad de acceso a mecanismos de protección imprescindibles para disminuir los riesgos que aquel implica? Consideramos que la bioética puede actuar como una herramienta que permita reflexionar sobre estos y otros aspectos a los que la actual pandemia nos enfrenta.
Asunto(s)
Bioética , COVID-19/terapia , Pediatras/ética , Adulto , COVID-19/transmisión , Niño , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pediatras/organización & administración , Equipo de Protección PersonalAsunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Pediatras/ética , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Betacoronavirus , Investigación Biomédica/ética , COVID-19 , Prioridades en Salud , Disparidades en Atención de Salud , Humanos , Salud Mental , Principios Morales , Evaluación de Necesidades , Pandemias , Distrés Psicológico , SARS-CoV-2 , Determinantes Sociales de la Salud , Factores SocioeconómicosRESUMEN
OBJECTIVES: SUBJECTS/METHODS: Moral distress is defined as "when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action". The Moral Distress Survey-Revised (MDS-R) is a validated 21-question survey measuring moral distress in pediatrics. The MDS-R was anonymously distributed to pediatric otolaryngology faculty and fellows at a tertiary institution. Descriptive statistics, bivariate and multivariate analysis were performed. RESULTS: Response rate was 89% (16/18). Overall MDS-R score was 40 (range 14-94), which is lower than that found in the literature for pediatric surgeons (reported mean 72), pediatric intensivists (reported means 57-86), and similar to pediatric oncologists (reported means 42-52). Fellows had a significantly higher level of moral distress than faculty (mean 69 vs. 26, p < 0.05). Factors leading to higher degrees of distress involved communication breakdowns and pressure from administration/insurance companies to reduce costs. CONCLUSION: Pediatric Otolaryngologists at our institution have lower degrees of moral distress compared to other pediatric subspecialists. Fellows had higher levels of distress compared to faculty. Further research is necessary to determine degrees of distress across institutions and to determine its impact on the wellness of pediatric otolaryngologists.
Asunto(s)
Principios Morales , Estrés Laboral/psicología , Otorrinolaringólogos/ética , Otorrinolaringólogos/psicología , Pediatras/ética , Pediatras/psicología , Distrés Psicológico , Adulto , Femenino , Encuestas Epidemiológicas , Hospitales Pediátricos/ética , Humanos , Relaciones Interprofesionales/ética , Masculino , Persona de Mediana Edad , Estrés Laboral/diagnóstico , Ohio , Proyectos PilotoAsunto(s)
Betacoronavirus , Infecciones por Coronavirus , Ética Médica , Obligaciones Morales , Otolaringología/ética , Pandemias/ética , Neumonía Viral , Adulto , COVID-19 , Infecciones por Coronavirus/epidemiología , Educación de Postgrado en Medicina , Humanos , Otolaringología/educación , Pediatras/ética , Neumonía Viral/epidemiología , SARS-CoV-2RESUMEN
Background: Previous research shows that pediatricians inconsistently utilize the ethics consultation service (ECS). Methods: Pediatricians in two suburban, Midwestern academic hospitals were asked to reflect on their ethics training and utilization of ECS via an anonymous, electronic survey distributed in 2017 and 2018, and analyzed in 2018. Participants reported their clinical experience, exposure to formal and informal ethics training, use of formal and informal ethics consultations, and potential barriers to formal consultation. Results: Less experienced pediatricians were more likely to utilize formal ethics consultation and more likely to have formal ethics training. The most commonly reported reasons not to pursue formal ECS consultation were inconvenience and self-reported expertise in pediatric ethics. Conclusions: These results inform ongoing discussions about ethics consultation among pediatricians and the role of formal ethics training in both undergraduate and graduate medical education.
Asunto(s)
Actitud del Personal de Salud , Educación Médica , Consultoría Ética , Ética Médica , Pediatras/ética , Pediatría/ética , Niño , Competencia Clínica , Ética Médica/educación , Femenino , Humanos , Masculino , Medio Oeste de Estados Unidos , Pediatras/educación , Pediatría/educación , Encuestas y CuestionariosRESUMEN
An estimated 8.7 million children live in a household with a substance-using parent or guardian. Substance-using caretakers may have impaired judgment that can negatively affect their child's well-being, including his or her ability to receive appropriate medical care. Although the physician-patient relationship exists between the pediatrician and the child, obligations related to safety and confidentiality should be considered as well. In managing encounters with impaired caretakers who may become disruptive or dangerous, pediatricians should be aware of their responsibilities before acting. In addition to fulfilling the duty involved with an established physician-patient relationship, the pediatrician should take reasonable care to safeguard patient confidentiality; protect the safety of their patient, other patients in the facility, visitors, and employees; and comply with reporting mandates. This clinical report identifies and discusses the legal and ethical concepts related to these circumstances. The report offers implementation suggestions when establishing anticipatory procedures and training programs for staff in such situations to maximize the patient's well-being and safety and minimize the liability of the pediatrician.
Asunto(s)
Trastornos Relacionados con Alcohol/psicología , Cuidadores/psicología , Juicio , Tutores Legales/psicología , Padres/psicología , Pediatras/ética , Trastornos Relacionados con Sustancias/psicología , Niño , Maltrato a los Niños , Protección a la Infancia , Confidencialidad , Humanos , Notificación Obligatoria , Consentimiento Paterno , Rol del Médico , Relaciones Médico-PacienteRESUMEN
OBJECTIVE: To delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care. DESIGN: We conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis. PARTICIPANTS: Participants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data. RESULTS: We performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians' convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence). CONCLUSIONS: This is the first qualitative study to demonstrate the framework of paediatricians' decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.