Can Parents Restrict Access to Their Adolescent's Voice?: Deciding About a Tracheostomy.

Parents are the default decision-makers for their infants and children. Their decisions should be based on the best interests of their children. Differing interpretations of children's best interests may be a source of conflict. Providers' biased evaluations of patients' quality of life may undermine medicine's trustworthiness. As children mature, they should participate in medical decision-making to the extent that is developmentally appropriate. In this month's Ethics Rounds, physicians, a philosopher, and a lawyer consider parents' demand, supported by the hospital's legal department, that their 17-year-old son be excluded from a potentially life-and-death medical decision.

Ethical Considerations in Pediatricians' Use of Social Media.

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.

Oral Health Matters: The Ethics of Providing Oral Health During COVID-19.

Oral health is a critical part of overall health. The current COVID-19 pandemic has highlighted the importance of oral health. In this article, we describe how dental practice has been impacted by COVID-19, identify the public health response to COVID-19, and explain the gradual resumption of dental care after the initial disruption due to the pandemic. Finally, we discuss how long-standing health disparities in oral health have been exacerbated by the current pandemic.

Transitioning from Adolescence to Adulthood with Autism Spectrum Disorder: An Overview of Planning and Legal Issues.

The transition to adulthood is complex. It is defined by many objective and subjective milestones. Transition from adolescence to young adulthood is challenging for both neurotypical individuals and individuals with autism spectrum disorders. However, for autistic individuals, this transition is even more complicated and poses a range of legal and ethical considerations. This article discusses how existing legal and social constructs may exacerbate rather than diminish barriers and access for autistic adults and identifies current and potential legal and policy solutions to reducing current systemic barriers. This article ultimately supports a supported decision-making model for autistic adolescents transitioning into adulthood.

"You took an Oath!": Engaging Medical Students About the Importance of Oaths and Codes Through Film and Television.

In this paper, we will consider the role of oaths and codes of ethics in undergraduate medical education. Studies of ethics syllabi suggest that ethics educators typically use well-known bioethics texts such as Beauchamp and Childress (Principles of biomedical ethics, 8th ed. Oxford University Press, Oxford, 2019). Yet, many issues that medical students will face (as students and as physicians) are addressed by codes of ethics and oaths. We will first provide a historical survey of oaths and codes and then address how these sources of ethical guidance can be effectively used in ethics education of medical students. Oaths and codes can be engagingly taught using a range of techniques including visual narrative. Excerpts from television and film can be used to highlight challenging ethical dilemmas in a variety of settings, taking the learning from the theoretical to the more applied while offering context.

The Ethics of Creating a Resource Allocation Strategy During the COVID-19 Pandemic.

The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalization for symptomatic infection, children nonetheless have the potential to be profoundly affected by the strain on the health care system imposed by the pandemic and should be considered prospectively in resource allocation frameworks.

Transitioning from Adolescence to Adulthood with Autism Spectrum Disorder: An Overview of Planning and Legal Issues.

The transition to adulthood is complex. It is defined by many objective and subjective milestones. Transition from adolescence to young adulthood is challenging for both neurotypical individuals and individuals with autism spectrum disorders. However, for autistic individuals, this transition is even more complicated and poses a range of legal and ethical considerations. This article discusses how existing legal and social constructs may exacerbate rather than diminish barriers and access for autistic adults and identifies current and potential legal and policy solutions to reducing current systemic barriers. This article ultimately supports a supported decision-making model for autistic adolescents transitioning into adulthood.

The Hospice Patient's Right to Oral Care: Making Time for the Mouth.

The hospice philosophy embraces palliative care for the terminally ill, for whom quality of life is the central focus of comfort care management. Often, caregivers hesitate or simply do not elect to extend oral care for patients nearing the end of life, due to difficulties encountered in patient compliance, a sense of futility in doing so, staff time constraints in prioritizing care, underfunding, or a lack of education as to how and why such care should be delivered to the hospice patient. This article aims to show physiological and psychosocial reasons why the hospice patient has a need for properly and regularly implemented oral care and why dental professionals have an ethical responsibility to address the current void that exists in hospice-centered oral care. Varying viewpoints are discussed regarding the need for oral health monitoring and maintenance in both the capable patient with capacity and in the patient who lacks capacity and is totally dependent, yet who exhibits no particular signs of oral distress nor desire for hygiene measures. Consideration is given to family dynamics in such care. Oral care of the elderly patients and terminally ill is sorely lacking, and dental educators are challenged to cultivate in students a sense of professional duty toward caring for the vulnerable elderly patients. Dental professionals should create initiatives in developing, promoting, and implementing an appropriate standard of oral care for the hospice patient.

A Life of One's Own: Challenges in the Transition from Childhood to Adulthood with Autism Spectrum Disorder.

This is a very delicate age for Cameron, with his eighteenth birthday looming like a big exit sign. Should I establish guardianship? Am I limiting his independence if I do? Am I putting him at risk if I don't? Will he be able to earn a meaningful living and be able to support himself? If not, are there supports available for him, aside from me? These questions weigh heavy on my mind, as time seems to speed up the older Cameron gets. I am encouraged by the pride Cameron shows in his independence, and hope that pride continues to grow, along with his independence.

WITHDRAWN: Initiation of the Society for Assisted Reproductive Technology Donor Egg Registry: a report from the Donor Egg Registry Task Force.

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