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3.
Anaesth Intensive Care ; 47(3_suppl): 6-16, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31674197

RESUMO

Dr Ian Hamilton McDonald (1923-2019) was a pioneer of paediatric anaesthesia and intensive care at the Royal Children's Hospital, Melbourne. He first started working at the hospital in the 1940s, later doing further training from 1953-1955 at the Nuffield Department of Anaesthesia in Oxford under Sir Robert Macintosh. McDonald returned to Melbourne as assistant director supporting Dr Margaret (Gretta) McClelland as the director of anaesthesia, together pioneering the development of a major paediatric anaesthesia department. McDonald, along with Dr John Stocks (1930-1974), was intimately involved in pioneering prolonged nasotracheal intubation in children, following on from earlier work by Dr Bernard Brandstater (an Australian working in Beirut), and Drs Tom Allen and Ian Steven in Adelaide. Ian McDonald was an influential, highly respected and greatly loved paediatric anaesthetist who had a profound influence on the early days of paediatric anaesthesia in Australia.


Assuntos
Anestesiologia/história , Pediatria/história , Anestesistas , Austrália , Criança , Cuidados Críticos , História do Século XX , Humanos
4.
Surg Clin North Am ; 99(6): 1177-1183, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676056

RESUMO

Pediatric inflammatory bowel disease may present differently than adult onset disease. It is important to consider a broader differential diagnosis in very early onset disease. Diagnostic and treatment decisions must consider the long term risks and benefits over a lifetime. Surgical triggers in children may include impaired growth and inability to wean from steroids in addition to standard adult indications. Effective transition of care to adult providers is a key to prevent flares and loss of follow-up.


Assuntos
Tratamento Conservador/métodos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/terapia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Feminino , Humanos , Masculino , Pediatria , Prognóstico , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Artigo em Chinês | MEDLINE | ID: mdl-31623034

RESUMO

Objective:To explore the early vowel perception development of pediatric cochlear implant(CI) of 1-3 years old. Method:A total of 123 children who had accepted cochlear implantation under 3 years old were analyzed retrospectively. According to the age of implantation, all participants were divided into two groups as 1 year old group(1-<2) and 2 years old group(2-<3). The vowel perception of mandarin early speech perception(MESP) test scores at 12, 24, 36 momths after implantation as well as the trends in vowel perception between group 1 and normal hearing pediatrics of the same age were analyzed to research the development of vowel perception in pediatric cochlear implants and the effect of implanted age as well as physiological age. Result:The scores improved notably in two groups with the increase of physiological age(P<0.01); The vowel perception of group 1 was significantly better than that of group 2(P<0.01), However, there were great difference between group 1 and normal hearing pediatrics of the same age. Conclusion:With the increase of physiological age, the vowel perception would be improved correspondingly within 3 years of pediatric cochlear implants under the age of 3; However, the earlier the age of implant, the better the vowel perception is.


Assuntos
Implantes Cocleares , Pediatria , Percepção da Fala , Pré-Escolar , Implante Coclear , Surdez , Humanos , Lactente , Estudos Retrospectivos
6.
ABC., imagem cardiovasc ; 32(4): 318-30, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1024061

RESUMO

A doença pulmonar hipertensiva pode ser definida como um conjunto de alterações fisiopatológicas pulmonares que resultam em uma patologia grave, progressiva e com alta morbimortalidade. O ecocardiograma transtorácico é um método de imagem de fácil acesso e essencial para avaliação desta doença, principalmente na faixa pediátrica, na qual há limitações para realização frequente e de rotina do cateterismo direito. Nesta revisão, abordaremos as principais técnicas ecocardiográficas para o diagnóstico e a avaliação hemodinâmica da hipertensão pulmonar na população pediátrica. O diagnóstico precoce e o adequado estadiamento no acompanhamento das intervenções clínicas são fundamentais para escolha assertiva da abordagem terapêutica e, consequentemente, melhora do desfecho clínico


Assuntos
Humanos , Masculino , Feminino , Pediatria , Ecocardiografia/métodos , Criança , Hipertensão Pulmonar/mortalidade , Artéria Pulmonar , Valva Tricúspide , Veia Cava Inferior , Cateterismo Cardíaco , Ecocardiografia Doppler/métodos , Disfunção Ventricular Direita , Disfunção Ventricular Esquerda , Átrios do Coração , Ventrículos do Coração
7.
ABCS health sci ; 44(2): 120-130, 11 out 2019. tab, ilus
Artigo em Português | LILACS | ID: biblio-1022353

RESUMO

O número de indivíduos diagnosticados com o transtorno do espectro autista (TEA) registrou aumento evidente na última década. Os principais sintomas, apresentados pelo portador, são neurológicos e digestórios, estando às intervenções nutricionais dentre as terapêuticas mais promissoras para amenizar a sintomatologia clínica. Assim, objetivou-se revisar sistematicamente os estudos sobre distúrbios alimentares e do trato gastrointestinal apresentado pelo indivíduo portador do TEA, a fim de compreender como o comportamento alimentar influência na etiopatogênese e manifestações clínicas da doença, com foco no eixo intestinocérebro. Para isso realizou-se uma revisão sistemática, seguindo as diretrizes PRISMA. A partir de uma busca estruturada e abrangente em bases de dados eletrônicas, 23 estudos foram recuperados e incluídos na revisão. Os critérios de inclusão definiam ser artigos originais relacionando o TEA com alterações nutricionais e/ou com o eixo intestino-cérebro. Após análise da composição da microbiota intestinal, os estudos mostraram um quadro de desequilíbrio. Foram encontradas, também, alterações na barreira de muco e permeabilidade intestinal e alterações em proteínas envolvidas na digestão e absorção de alimentos. Dietas restritivas e a modulação da microbiota, com uso de probióticos e de antibióticos específicos, são apresentadas como estratégias terapêuticas adjuvantes promissoras. Conclui-se que o eixo intestino-cérebro está envolvido tanto na etiologia, quanto nas manifestações clínicas do TEA. Porém, não sendo certo se alterações intestinais são causa ou consequência das alterações neurológicas. Até o presente momento, a comunidade científica não tem conclusões suficientes para indicar o uso de dietas restritivas, e uso de probióticos e de antibióticos como terapêutica para o TEA.


The number of individuals diagnosed with autism spectrum disorder (ASD) had an evident increase in the last decade. The primary symptoms exhibited amongst these patients were mostly digestive and neurological disorders; with nutritional interventions being one of the most promising therapies to assuage this clinical symptomology. As such, following the PRISMA guidelines, we systematically reviewed the research studies apropos of the ASD patients manifesting said digestive disorders, to comprehend how dietary behavior can influence the etiopathogenesis and clinical manifestations of the disease, with primary focus on the gut-brain axis. From a comprehensive and structured search through electronic databases, 23 studies were retrieved and admitted in this review. The inclusion criteria defined that there be original articles consociating ASD with nutritional disorders and/or with the gut-brain axis. These studies analyzed the composition of the intestinal flora of diagnosed patients, subsequently discerning cases of varying imbalances. Alterations in the gene expression of the proteins involved in the digestion and absorption of food, the mucous barrier and the intestinal permeability were described. Accordingly, restrictive diets and the modulation of the microbiota by administering specific anti- & probiotics were initially identified as promissory therapies. In conclusion, the gut-brain axis was observed to be a determinant factor in both the etiology and clinical symptomology of ASD - though it is still debatable the correlation of intestinal alterations with neurological changes. At present, there is no concrete scientific proof accrediting to restrictive diets and the use of specific anti- & probiotics, as successful treatments for ASD.


Assuntos
Humanos , Pré-Escolar , Criança , Ciências da Nutrição Infantil , Cérebro , Transtorno do Espectro Autista , Intestinos , Neurotoxinas , Pediatria
8.
Pharm Res ; 36(12): 171, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31654287

RESUMO

PURPOSE: Physiologically-based pharmacokinetic (PBPK) modeling offers a unique modality to predict age-specific pharmacokinetics. The objective of this study was to assess the ability of PBPK model to predict plasma exposure of oxycodone, a widely used opioid for pain management, in adults and children. METHODS: A full PBPK model of oxycodone following intravenous and oral administration was developed using a 'bottom-up' and 'top-down' combined strategy. The model was then extrapolated to pediatrics through a reasonable scaling method. The adult and pediatric model was evaluated using data from 17 clinical PK studies by testing predicted/observed goodness of fit. The mean fold error for PK parameters was calculated. Finally, we used the validated PBPK model to visualize adult-children dose conversion for oxycodone. RESULTS: The developed PBPK model successfully predicted the oxycodone disposition in adults, wherein the predicted versus observed AUC, Cmax, and tmax were within 0.90 to 1.20-fold difference. After scaling anatomy/physiology, protein binding, and clearance, the model showed satisfactory prediction performance for pediatric populations as predicted AUC were within the 1.50-fold range of the observed values. According to the application of PBPK model, we found that different intravenous doses should be given in children of different ages compared to a standard 0.1 mg/kg in adults, while a progressive increasing dose with age growth following oral administration is recommended for children. CONCLUSIONS: The current example provides the opportunity for using the PBPK model to guide dose adjustment of oxycodone in the design of future pediatric clinical studies.


Assuntos
Analgésicos Opioides/farmacocinética , Oxicodona/farmacocinética , Administração Intravenosa , Administração Oral , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Criança , Pré-Escolar , Simulação por Computador , Relação Dose-Resposta a Droga , Humanos , Lactente , Recém-Nascido , Taxa de Depuração Metabólica , Modelos Biológicos , Oxicodona/administração & dosagem , Pediatria
9.
Ideggyogy Sz ; 72(9-10): 325-336, 2019 Sep 30.
Artigo em Húngaro | MEDLINE | ID: mdl-31625699

RESUMO

With the acceptance of "The developmental origins of health and disease" concept in the 1990s, it became clear that epigenetic inheritance, which do not involve changes in the DNA sequence has important role in the pathogenesis of diseases. Epigenetic regulation serves the adaptation to the changing environment and maintains the reproductive fitness even on the drawback of increased risk of diseases in later life. The role of epigenetic mechanisms in chronic non-communicable diseases has been well established. Recent studies have revealed that epigenetic changes have also causal role in certain pediatric diseases. The review evaluates the recent epigenetic findings in the pathomechanism of common pediatric diseases. The wide range and long-lasting duration of epigenetic regulations give importance to the subject. Methods are already available to evaluate a part of the epigenetic changes in the clinical practice, presently aiming primarily the estimation of the disease risk or definition of diagnosis. Furthermore, there are already available limited means to influence the epigenetic regulation.


Assuntos
Metilação de DNA/fisiologia , Epigênese Genética , Cardiopatias , Infecção , Transtornos Mentais , Doenças Metabólicas , Efeitos Tardios da Exposição Pré-Natal , Criança , Pré-Escolar , Metilação de DNA/genética , Feminino , Cardiopatias/genética , Humanos , Infecção/genética , Transtornos Mentais/genética , Doenças Metabólicas/genética , Pediatria , Gravidez , Efeitos Tardios da Exposição Pré-Natal/genética
10.
Am J Disaster Med ; 14(2): 75-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637688

RESUMO

OBJECTIVE: To assess emergency medical services (EMS) and hospital disaster plans and communication and promote an integrated pediatric disaster response in the state of Connecticut, using tabletop exercises to promote education, collaboration, and planning among healthcare entities. DESIGN: Using hospital-specific and national guidelines, a disaster preparedness plan consisting of pediatric guidelines and a hospital checklist was created by The Connecticut Coalition for Pediatric Disaster Preparedness. SETTING: Five school bus rollover tabletop exercises were conducted, one in each of Connecticut's five EMS regions. Action figures and playsets were used to depict patients, healthcare workers, vehicles, the school, and the hospital. PARTICIPANTS: EMS personnel, nurses, physicians and hospital administrators. INTERVENTION: Participants had a facilitated debriefing of the EMS and prehospital response to disasters, communication among prehospital organizations, public health officials, hospitals, and schools, and surge capacity, capability, and alternate care sites. A checklist was completed for each exercise and was used with the facilitated debriefing to generate an afteraction report. Additionally, each participant completed a postexercise survey. MAIN OUTCOME MEASURES: Each after-action report and postexercise survey was compared to established guidelines to address gaps in hospital specific pediatric readiness. RESULTS: Exercises occurred at five hospitals, with inpatient capacity ranging 77-1,592 beds, and between 0 and 221 pediatric beds. There were 27 participants in the tabletop exercises, and 20 complete survey responses for analysis (74 percent). After the exercises, pediatric disaster preparedness aligned with coalition guidelines. However, methods of expanding surge capacity and methods of generating surge capacity and capability varied (p < 0.031). CONCLUSION: Statewide tabletop exercises promoted coalition building and revealed gaps between actual and ideal practice. Generation of surge capacity and capability should be addressed in future disaster education.


Assuntos
Planejamento em Desastres , Desastres , Lista de Checagem , Criança , Connecticut , Humanos , Pediatria , Capacidade de Resposta ante Emergências
11.
Rev Med Liege ; 74(10): 503-507, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31609552

RESUMO

Malaria is a life-threatening infection which affects especially non-immune subjects including children under the age of 5. Imported malaria is a rare disease in Europe but, with the increasing number of travelers and people who are visiting friends or relatives, it is important not to neglect it. Severe malaria leads to many pediatric deaths in countries with limited resources. The treatment of choice is a parenteral antimalarial. For a long time, only quinine was used in that case. Based on strong studies conducted in Asia and Africa, WHO (World Health Organization) has recommended the use of artesunate as a first-line treatment for severe malaria in adults and children since 2010.The use of artesunate has shown a reduction in mortality rate in severe malaria. In Europe, there still are several barriers to the implementation of these recommendations, especially in terms of availability and cost. In pediatrics departments and adults, artesunate is the first-line treatment in severe malaria, although close monitoring is essential, especially at the hematological side, monitoring the development of delayed post-artesunate haemolytic anemia (PADH), a known side effect.


Assuntos
Antimaláricos , Artemisininas , Artesunato , Malária , Antimaláricos/uso terapêutico , Artesunato/uso terapêutico , Criança , Europa (Continente) , Humanos , Malária/tratamento farmacológico , Pediatria
12.
Zhonghua Shao Shang Za Zhi ; 35(10): 712-714, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31658540

RESUMO

Children are a special group, which have unique physiological characteristics and are still in the period of physical and mental growth and development, thus the prevention and treatment of scar in children are different from that in adults. Scar management in children is a complex and multifaceted system engineering. The grade of scar in children needs to be adjusted according to the age, period, and severity. Corresponding method needs to be chosen for the treatment of scar in children according to the classification of the scar. The compliance of children is poor, and the key to scar treatment is the persistence and cooperation of the parents, so doctors should strengthen propaganda and education to the parents of children with scar. For children with scar, individualized and comprehensive treatment should be used according to the characteristics of children to achieve good results.


Assuntos
Queimaduras/terapia , Cicatriz/reabilitação , Adulto , Queimaduras/complicações , Criança , Cicatriz/etiologia , Humanos , Pais , Pediatria
13.
J Clin Ethics ; 30(3): 183-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573960

RESUMO

Healthcare decision making for children has adopted the best interest of the child standard, a principle originally employed by judges to adjudicate child placement in the case of parental death, divorce, or incompetence. Philosophers and medical ethicists have argued whether the best interest principle is a guidance principle (informing parents on how they should make healthcare decisions for their child), an intervention principle (deciding the limits of parental autonomy in healthcare decision making), or both. Those who defend it as only a guidance principle often cite the harm principle as the appropriate intervention principle. In this article, I challenge current use of the best interest principle in pediatric decision making as a guidance principle and as an intervention principle. I propose a model that I call constrained parental autonomy, which focuses on promoting and protecting the child's primary goods or basic needs. I show that constrained parental autonomy can serve as both a guidance principle and an intervention principle in making decisions. I conclude by examining a case study involving bone marrow donation by a young child to her sister.


Assuntos
Tomada de Decisões , Pais , Pediatria , Criança , Humanos , Pediatria/ética
14.
J Clin Ethics ; 30(3): 196-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573961

RESUMO

Ross's argument against the best interest standard (BIS) makes a clear case for the problems of the BIS, and she also notes challenges with such notions as the harm principle. In light of these critiques, Ross champions her longstanding pediatric moral norm for decision making, constrained parental autonomy (CPA). This article argues that while Ross's critique of the traditional accounts of the BIS is correct, her solution still raises some concerns. As such, I offer the "reasonable interests standard" as a way of addressing what I see as weaknesses in both the BIS and CPA.


Assuntos
Tomada de Decisões , Princípios Morais , Pediatria , Criança , Humanos , Pediatria/ética
15.
J Clin Ethics ; 30(3): 201-206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573962

RESUMO

Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians' and parents' decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child's basic needs or primary goods, and both physicians and parents should be guided by a commitment to protect a child's basic needs and primary goods. In contrast, we argue that no principle-neither Ross's CPA, nor the best interest standard or the harm threshold-can serve as both an intervention principle and a guidance principle. First, there are as many correct intervention principles as there are different kinds of interventions, since different kinds of interventions can be justified under different conditions. Second, physicians and parents have different guidance principles, because the decisions physicians and parents make for a child should be informed by different values and balanced by different (potentially) conflicting commitments.


Assuntos
Tomada de Decisões , Pediatria , Médicos , Criança , Diversidade Cultural , Humanos , Pais
16.
J Clin Ethics ; 30(3): 207-212, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573963

RESUMO

Thirty years ago, Buchanan and Brock distinguished between guidance principles and interference principles in the setting of surrogate decision making on behalf of children and incompetent adult patients. They suggested that the best interest standard could serve as a guidance principle, but was insufficient as an interference principle. In this issue of The Journal of Clinical Ethics, Ross argues that the best interest standard can serve as neither a guidance or interference principle for decision making on behalf of children, but that her model of constrained parental autonomy can serve as both. I will argue that Buchanan and Brock were correct that a single model or standard cannot serve as both a guidance and interference principle in pediatrics and that the best interest standard is a sufficient guidance principle. The harm principle fulfills the conditions necessary for an interference principle, at least insofar as deciding when state intervention to interfere with parental decision making is justified.


Assuntos
Tomada de Decisões , Pais , Pediatria , Adulto , Criança , Feminino , Redução do Dano , Humanos , Pediatria/ética
17.
J Clin Ethics ; 30(3): 213-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573964

RESUMO

In this commentary, the author discusses two strengths and two weaknesses of "Better than Best (Interest Standard) in Pediatric Decision-Making," in which Lainie Friedman Ross critiques the best interest standard and proposes her own model of constrained parental autonomy (CPA) as a preferable replacement for both an intervention principle and a guidance principle in pediatric decision making. The CPA's strengths are that it detaches from the language and concept of "best" and that it better respects the family as a distinct and intimate decision-making unit. The first weakness of the framework, as an intervention principle, is that because it imports a Rawlsian understanding of basic interests, it neglects certain populations of children (for example, children with intellectual disabilities). The second weakness is that, as a guidance principle, it is unclear what actual guidance the CPA is positioned to offer and how that guidance would be justified. To conclude, this commentary offers suggestions for what should be required of both an intervention principle and a guidance principle in pediatric decision making.


Assuntos
Tomada de Decisões , Pais , Pediatria , Criança , Humanos , Pediatria/ética
18.
J Clin Ethics ; 30(3): 223-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573966

RESUMO

While the best interest standard (BIS) enjoys wide endorsement as ethical and decision-making standard in pediatrics, it has been criticized as vague and indeterminate. Alternate decision-making standards have been proposed to replace or augment the BIS, notably the harm principle (HP) and constrained parental autonomy (CPA) model. In this edition of The Journal of Clinical Ethics, Lainie Friedman Ross argues that CPA is a better standard than the BIS or the HP as both guide and limiter in pediatrics. In response, I review the important work done by the BIS in pediatrics, and argue that neither the HP nor the CPA can take over these functions or replace the BIS. Among other things I argue: (1) The BIS provides more robust protections for the moral claims of children. (2) The CPA model and the HP do not resolve the indeterminacy and vagueness present in complex medical situations, and the BIS is better suited to deal with this vagueness and indeterminacy. (3) The BIS is a general principle of medical ethics with special application in pediatrics; it fits seamlessly into the system of medical ethics and fulfills many functions within pediatrics. The HP and the CPA model do not fit in so readily within medical ethics, and are not equipped to take over the functions of the BIS.


Assuntos
Tomada de Decisões , Redução do Dano , Pais , Pediatria , Autonomia Pessoal , Criança , Ética Clínica , Ética Médica , Humanos , Padrão de Cuidado
19.
J Clin Ethics ; 30(3): 232-239, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573967

RESUMO

In their thoughtful critiques of my article "Better than Best (Interest Standard) in Pediatric Decision Making," my colleagues make clear that there is little consensus on what is (are) the appropriate guidance and intervention principles in pediatric decision making, and disagree about whether one principle can serve both functions. Hester proposes his own unitary principle, the reasonable interest standard, which, like the best interest standard from which it is derived, encourages parents to aim for the great, although Hester tempers it with a pragmatic principle that allows consideration of cultural and family values and practical, financial, social, or psychological circumstances. I reject the aspirational guidance principle because it is too demanding, and I also reject the notion that this pragmatic condition "gives permission for others to extol parents to give reasons" for their decisions, because it allows too much interference into the family and its decision making. Whereas the other respondents and I focus on whether and when third parties should intervene in the doctor-patient (surrogate) relationship, Navin and Wasserman mistakenly redefine intervention to include physicians' behaviors that attempt to influence parents, ignoring the integral role of shared decision making-a bidirectional discussion in which physicians help patients (surrogates) select among reasonable medical options through education, and, when necessary, motivation or persuasion. Diekema and Salter focus on the harm principle for intervention, ignoring other conditions in which intervention may be appropriate and institutions other than the state that may intervene. Paquette's overly narrow interpretation of who has positive obligations to children fails to ensure that a child's basic interests and needs are met. Finally, Bester claims that the "need to choose the available option that best promotes or protects the child's basic interests" is akin to a focus on best interests. But constrained parental autonomy does not require parents to choose the option that best promotes a child's basic interests. Rather, it requires respect for broad parental discretion about how they raise their child unless their decisions fail to promote the child's basic needs and interests.


Assuntos
Tomada de Decisões , Pais , Pediatria , Médicos , Criança , Humanos , Pediatria/ética , Relações Médico-Paciente
20.
J Clin Ethics ; 30(3): 240-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573968

RESUMO

What process ought to guide decision making for pediatric patients? The prevailing view is that decision making should be informed and guided by the best interest of the child. A widely discussed structural model proposed by Buchanan and Brock focuses on parents as surrogate decision makers and examines best interests as guiding and-or intervention principles. Working from two recent articles by Ross on "constrained parental autonomy" in pediatric decision making (which is grounded in the Buchanan and Brock model), I discuss (supportively) features of Ross's effort vis-a-vis the best interest standard. I argue that any pediatric decision-making model that brackets or formally limits an engagement with the child patient assumes too much. Further, any model that under appreciates the place of parents and their autonomy, and the dynamic parent-child relationship, misses an opportunity to broaden the clinical encounter by considering questions of justice for the child (Rawls) and within a family (Ross). In this context, I focus on the child's emerging and ongoing emotional and intellectual development and autonomy¬-their capabilities and identifying primary goods.


Assuntos
Tomada de Decisões , Pais , Pediatria , Criança , Humanos , Pediatria/ética
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