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2.
Pediatrics ; 146(Suppl 1): S3-S8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737225

RESUMO

One of the earliest controversies in the modern history of bioethics was known at the time as "the Hopkins Mongol case," involving an infant with Trisomy 21 and duodenal atresia whose parents declined to consent to surgery. Fluids and feeding were withheld, and the infant died of dehydration after 15 days. The child's short life had a profound impact on the author's career and that of several others and ultimately led to changes in the care of children and adults with disabilities and the way difficult end-of-life decisions are made in US hospitals today. It also contributed to the growth of the modern bioethics movement and scholarship focused on pediatric bioethics issues.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Pediatria/ética , Suspensão de Tratamento/ética , Comitês Consultivos/ética , Temas Bioéticos/história , Temas Bioéticos/legislação & jurisprudência , Crianças com Deficiência/legislação & jurisprudência , Síndrome de Down/história , Atresia Esofágica/história , Atresia Esofágica/terapia , Fundações , História do Século XX , Humanos , Recém-Nascido , Consentimento dos Pais/ética , Consentimento dos Pais/legislação & jurisprudência , Pais , Pediatria/legislação & jurisprudência , Assistência Terminal/ética , Suspensão de Tratamento/legislação & jurisprudência
3.
Pediatrics ; 146(Suppl 1): S9-S12, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737226

RESUMO

The "Baby Doe" case of the early 1980s was marked by considerable controversy, primarily regarding the legal response of the federal government to the case at the time. In the decades that followed, the decision-making for children with trisomy 21, like Baby Doe, has been substantially reevaluated. The data, the assumptions about quality of life that were based on those data, and the ethical principles underpinning the decision-making in the Baby Doe case have all evolved significantly over time. The present strategies for decision-making for children with trisomy 13 and 18 appear to be following a similar pattern. The data, quality-of-life assumptions based on those data, and even the ethical principles underlying the decision-making for these children are currently being reexamined. Children with trisomy 13 and 18 are, in this regard, the next Baby Doe(s).


Assuntos
Tomada de Decisão Clínica/ética , Síndrome de Down/terapia , Síndrome da Trissomia do Cromossomo 13/terapia , Síndrome da Trissomía do Cromossomo 18/terapia , Desenvolvimento Infantil , Atresia Esofágica , Humanos , Recém-Nascido , Estimativa de Kaplan-Meier , Pais , Qualidade de Vida , Síndrome da Trissomia do Cromossomo 13/mortalidade , Síndrome da Trissomía do Cromossomo 18/mortalidade , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência
4.
Pediatrics ; 146(Suppl 1): S13-S17, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737227

RESUMO

Although parents are typically the most appropriate decision-makers for their children, there are limits to this authority. Medical providers may be ethically obligated to seek state intervention against a parental decision if the parent places a child at significant and imminent risk of serious harm. When parents make medical decisions for their children, they assess both the projected benefits and risks of their choices for their family. These assessments are impacted by uncertainty, which is a common feature of neonatal intensive care. The relative presence or absence of uncertainty may impact perceptions of parental decisions and a medical provider's decision to seek state intervention to overrule parents. In this article, we propose a model integrating prognostic uncertainty into pediatric decision-making that may aid providers in such assessments. We will demonstrate how to apply this model to 3 neonatal cases and propose that the presence of greater uncertainty ought to permit parents greater latitude to incorporate family values into their decision-making even if these decisions are contradictory to the recommendations of the medical team.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Pais , Incerteza , Família , Feminino , Idade Gestacional , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Cuidados Paliativos , Consentimento dos Pais/ética , Prognóstico , Estenose da Valva Pulmonar/cirurgia , Valores Sociais , Suspensão de Tratamento/ética
5.
Pediatrics ; 146(Suppl 1): S54-S59, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737233

RESUMO

In 2017, the court case over medical treatment of UK infant, Charlie Gard, reached global attention. In this article, I will analyze one of the more distinctive elements of the case. The UK courts concluded that treatment of Charlie Gard was not in his best interests and that it would be permissible to withdraw life-sustaining treatment. However, in addition, the court ruled that Charlie should not be transferred overseas for the treatment that his parents sought, even though specialists in Italy and the US were willing to provide that treatment. Is it ethical to prevent parents from pursuing life-prolonging treatment overseas for their children? If so, when is it ethical to do this? I will outline arguments in defense of obstructing transfer in some situations. I will argue, however, that this is only justified if there is good reason to think that the proposed treatment would cause harm.


Assuntos
Temas Bioéticos , Futilidade Médica/ética , Transferência de Pacientes/ética , Suspensão de Tratamento/ética , Dissidências e Disputas , História do Século XXI , Humanos , Internacionalidade , Malformações Arteriovenosas Intracranianas/terapia , Itália , Masculino , Futilidade Médica/legislação & jurisprudência , Turismo Médico/ética , Turismo Médico/legislação & jurisprudência , Pais , Transferência de Pacientes/legislação & jurisprudência , Recusa do Médico a Tratar/ética , Recusa do Médico a Tratar/legislação & jurisprudência , Texas , Traqueostomia/ética , Traqueostomia/legislação & jurisprudência , Reino Unido , Estados Unidos , Suspensão de Tratamento/legislação & jurisprudência
6.
Pediatrics ; 146(Suppl 1): S60-S65, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737234

RESUMO

Charlie Gard (August 4, 2016, to July 28, 2017) was an infant in the United Kingdom who was diagnosed with an encephalopathic form of mitochondrial DNA depletion syndrome caused by a mutation in the RRM2B gene. Charlie's parents raised £1.3 million (∼$1.6 million US) on a crowdfunding platform to travel to New York to pursue experimental nucleoside bypass treatment, which was being used to treat a myopathic form of mitochondrial DNA depletion syndrome caused by mutations in a different gene (TK2). The case made international headlines about what was in Charlie's best interest. In the medical ethics community, it raised the question of whether best interest serves as a guidance principle (a principle that provides substantive directions as to how decisions are to be made), an intervention principle (a principle specifying the conditions under which third parties are to intervene), both guidance and intervention, or neither. I show that the United Kingdom uses best interest as both guidance and intervention, and the United States uses best interest for neither. This explains why the decision to withdraw the ventilator without attempting nucleoside bypass treatment was the correct decision in the United Kingdom and why the opposite conclusion would have been reached in the United States.


Assuntos
Proteínas de Ciclo Celular/genética , Encefalomiopatias Mitocondriais/terapia , Defesa do Paciente/ética , Respiração Artificial/ética , Ribonucleotídeo Redutases/genética , Suspensão de Tratamento/ética , Tomada de Decisão Clínica/ética , Crowdsourcing/economia , História do Século XXI , Humanos , Lactente , Masculino , Futilidade Médica/ética , Encefalomiopatias Mitocondriais/genética , Cidade de Nova Iorque , Poder Familiar , Defesa do Paciente/legislação & jurisprudência , Transferência de Pacientes/ética , Transferência de Pacientes/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Timidina Quinase/genética , Reino Unido , Estados Unidos , Suspensão de Tratamento/legislação & jurisprudência
7.
Pediatrics ; 146(Suppl 1): S66-S69, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737235

RESUMO

In all of medicine, there is perhaps nothing so distressing as bearing witness to a patient's suffering, especially if that patient is a child. We want to do everything that we can to avoid or alleviate a child's suffering, yet what do clinicians, ethicists, lawyers, or family members mean when they use the term "suffering," and how should these claims of suffering factor into pediatric decision-making? This question of suffering and what to do about it has played a key role in several prominent pediatric cases over the past decade, including the cases of Charlie Gard, Alfie Evans, and Baby Joseph. These cases have become seminal cases precisely because there is no clear resolution, and the "suffering child" continues to challenge our moral ideals of what it means to live a good life. In this article, I explore the various ways in which the concept of suffering is used in these cases, and I offer new ways in which parents, providers, and all those who work with sick children can approach the suffering child.


Assuntos
Tomada de Decisão Clínica/ética , Doença de Leigh , Encefalomiopatias Mitocondriais , Doenças Neurodegenerativas , Terminologia como Assunto , Suspensão de Tratamento/ética , História do Século XXI , Humanos , Lactente , Doença de Leigh/diagnóstico , Doença de Leigh/psicologia , Doença de Leigh/terapia , Masculino , Encefalomiopatias Mitocondriais/terapia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/psicologia , Doenças Neurodegenerativas/terapia , Ontário , Pais/psicologia , Estado Vegetativo Persistente/psicologia , Estado Vegetativo Persistente/terapia , Qualidade de Vida , Respiração Artificial/ética , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Traqueostomia/psicologia , Reino Unido , Suspensão de Tratamento/legislação & jurisprudência
8.
Pediatrics ; 146(Suppl 1): S70-S74, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737236

RESUMO

The alleviation of suffering has always been central to the care of the sick. Yet as medical technology has advanced and life-sustaining treatments multiplied, medicine's capacity to both prevent and create suffering has grown exponentially. In pediatric medicine, the ability to stave off death with life-sustaining treatments allows children to survive but also to suffer in ways that are diverse and unprecedented. However, although parents and pediatric clinicians broadly agree that all children can suffer, there is little published literature in which researchers analyze or clarify the concept of pediatric suffering. This gap is worrisome, especially in light of growing concerns that the label of suffering is used to justify end-of-life decision-making and mask quality-of-life determinations for pediatric patients with profound neurologic impairment. Moreover, the awareness that some children can experience suffering but cannot communicate whether and how they are suffering creates a problem. Does the determination of suffering in a nonverbal child lie in the judgement of clinicians or parents? In this article, I will address several important questions related to the suffering of children through an analysis of two prevalent conceptualizations of pediatric suffering and suggest a possible avenue forward for future scholarship.


Assuntos
Temas Bioéticos , Tomada de Decisão Clínica/ética , Percepção da Dor/fisiologia , Angústia Psicológica , Terminologia como Assunto , Bibliometria , Criança , Pré-Escolar , Dissidências e Disputas , Humanos , Lactente , Futilidade Médica/ética , Comunicação não Verbal/fisiologia , Percepção da Dor/ética , Qualidade de Vida , Suspensão de Tratamento/ética
9.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732263

RESUMO

With increasing focus in the last decade on post-cardiac arrest care in pediatrics, return of spontaneous circulation, survival rates, and neurologic outcome have improved. As part of this postarrest care, both the American Heart Association and the American Academy of Neurology state it is reasonable to consider targeted temperature management in pediatric comatose patients, although this care is challenging and time sensitive, with many gaps in knowledge remaining. Many pediatric patients will still not survive or will suffer severe neurocognitive impairment despite the therapeutic arsenal provided. Adult guidelines suggest providing postarrest supportive care and limiting prognosis discussions with families until after 72 hours of therapy, but pediatric clinicians are advised to consider a multitude of factors given the lack of data. What, then, should clinicians do if family members of a patient who has been resuscitated request the withdrawal of all life support in the 24 hours immediately postarrest? In this Ethics Rounds, we present such a case and the responses of different clinicians and bioethicists.


Assuntos
Eutanásia Passiva/ética , Parada Cardíaca/terapia , Ressuscitação , Suspensão de Tratamento/ética , Tomada de Decisão Clínica/ética , Eletroencefalografia , Humanos , Hipotermia Induzida , Lactente , Prognóstico
11.
J Pak Med Assoc ; 70(Suppl 3)(5): S145-S148, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-592825

RESUMO

In a short span of a few weeks, the COVID-19 pandemic has affected the entire world like no other event in modern history. Healthcare institutions and providers have been at the forefront of containing the ravages of this disease, and are experiencing unprecedented challenges. Medical decision making has become all the more complex because of the moral weight of difficult decisions that need to be made. This paper discusses three areas where ethical decision making is extremely important: dealing with those patients with COVID-19 who no longer have access to their doctors; following ethical criteria for assigning risky duties to healthcare professionals; and in making life and death decisions while allocating scarce resources. This paper describes a national level guidance document for the COVID-19 pandemic that is designed to facilitate ethical decision-making.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/ética , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Alocação de Recursos/ética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Assistência à Saúde/ética , Humanos , Paquistão , Pandemias/ética , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Suspensão de Tratamento/ética
12.
J Pak Med Assoc ; 70(Suppl 3)(5): S145-S148, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-609379

RESUMO

In a short span of a few weeks, the COVID-19 pandemic has affected the entire world like no other event in modern history. Healthcare institutions and providers have been at the forefront of containing the ravages of this disease, and are experiencing unprecedented challenges. Medical decision making has become all the more complex because of the moral weight of difficult decisions that need to be made. This paper discusses three areas where ethical decision making is extremely important: dealing with those patients with COVID-19 who no longer have access to their doctors; following ethical criteria for assigning risky duties to healthcare professionals; and in making life and death decisions while allocating scarce resources. This paper describes a national level guidance document for the COVID-19 pandemic that is designed to facilitate ethical decision-making.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/ética , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Alocação de Recursos/ética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Assistência à Saúde/ética , Humanos , Paquistão , Pandemias/ética , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Suspensão de Tratamento/ética
13.
J Pak Med Assoc ; 70(Suppl 3)(5): S145-S148, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32515398

RESUMO

In a short span of a few weeks, the COVID-19 pandemic has affected the entire world like no other event in modern history. Healthcare institutions and providers have been at the forefront of containing the ravages of this disease, and are experiencing unprecedented challenges. Medical decision making has become all the more complex because of the moral weight of difficult decisions that need to be made. This paper discusses three areas where ethical decision making is extremely important: dealing with those patients with COVID-19 who no longer have access to their doctors; following ethical criteria for assigning risky duties to healthcare professionals; and in making life and death decisions while allocating scarce resources. This paper describes a national level guidance document for the COVID-19 pandemic that is designed to facilitate ethical decision-making.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/ética , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Alocação de Recursos/ética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Assistência à Saúde/ética , Humanos , Paquistão , Pandemias/ética , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Suspensão de Tratamento/ética
14.
J Med Ethics ; 46(8): 495-498, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32522813

RESUMO

Key ethical challenges for healthcare workers arising from the COVID-19 pandemic are identified: isolation and social distancing, duty of care and fair access to treatment. The paper argues for a relational approach to ethics which includes solidarity, relational autonomy, duty, equity, trust and reciprocity as core values. The needs of the poor and socially disadvantaged are highlighted. Relational autonomy and solidarity are explored in relation to isolation and social distancing. Reciprocity is discussed with reference to healthcare workers' duty of care and its limits. Priority setting and access to treatment raise ethical issues of utility and equity. Difficult ethical dilemmas around triage, do not resuscitate decisions, and withholding and withdrawing treatment are discussed in the light of recently published guidelines. The paper concludes with the hope for a wider discussion of relational ethics and a glimpse of a future after the pandemic has subsided.


Assuntos
Tomada de Decisões/ética , Ética Clínica , Alocação de Recursos para a Atenção à Saúde/ética , Equidade em Saúde/ética , Pessoal de Saúde/ética , Pandemias/ética , Betacoronavirus , Infecções por Coronavirus/virologia , Planejamento em Desastres , Humanos , Obrigações Morais , Pneumonia Viral/virologia , Pobreza , Guias de Prática Clínica como Assunto , Relações Profissional-Paciente , Ordens quanto à Conduta (Ética Médica) , Valores Sociais , Triagem/ética , Populações Vulneráveis , Suspensão de Tratamento/ética
15.
J Clin Ethics ; 31(2): 111-125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32585654

RESUMO

INTRODUCTION: In highly developed countries, as many as 16 percent of children are physically abused each year. Traumatic brain injury (TBI) is the most common injury in non-accidental trauma (NAT) and is responsible for 80 percent of fatal NAT cases, with most deaths occurring in children younger than three years old. Cases of abusers who refuse withdrawal of life-sustaining medical treatment (LSMT) to avoid criminal charges have previously been reported. Therefore, we hypothesized that NAT is associated with a lower risk for withdrawal LSMT in pediatric TBI. METHODS: The pediatric Trauma Quality Improvement Program database was analyzed (2014 to 2016) for patients aged 16 and younger with TBI and Glasgow Coma Scale (GCS) of 8 and lower on admission. Patients with a head Abbreviated Injury Scale (AIS) of 2 or less or who died within 48 hours were excluded. A multivariable logistic regression model was used for analysis. RESULTS: Of 2,209 TBI patients, 92 (4.2 percent) had withdrawal of LSMT. Compared to those without withdrawal of LMST, those with LMST had statistically similar median age (three years of age versus seven years) and a higher rate of NAT (33.7 percent versus 13.5 percent). The most common specified perpetrator was a father/stepfather/male partner (70 percent). After adjusting for covariates, factors associated with higher risk for withdrawal of LSMT included age of less than three years (OR 2.38, CI 1.34-4.23) and NAT (OR 1.86, CI 1.02-3.41). CONCLUSION: NAT is associated with increased risk for withdrawal of LSMT in pediatric TBI. Age of less than three years is similarly associated with a higher risk for withdrawal of LSMT. Future research in this population is needed to determine what other factors predict withdrawal of LSMT and what resources, such as social workers and/or ethics consults, are utilized.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas , Cuidados para Prolongar a Vida , Suspensão de Tratamento , Adolescente , Criança , Pré-Escolar , Escala de Coma de Glasgow , Humanos , Cuidados para Prolongar a Vida/ética , Masculino , Estudos Retrospectivos , Suspensão de Tratamento/ética
16.
New Bioeth ; 26(2): 176-189, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32364048

RESUMO

The paper considers the recently published British Medical Association Guidance on ethical issues arising in relation to rationing of treatment during the COVID-19 Pandemic. It considers whether it is lawful to create policies for the rationing and withdrawal of treatment, and goes on to consider how such policies might apply in practice. Legal analysis is undertaken of certain aspects of the Guidance which appear to misunderstand the law in respect of withdrawing treatment.


Assuntos
Infecções por Coronavirus/terapia , Alocação de Recursos para a Atenção à Saúde/ética , Política de Saúde , Pandemias/ética , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Suspensão de Tratamento/ética , Suspensão de Tratamento/legislação & jurisprudência , Betacoronavirus , Humanos , Sociedades Médicas , Reino Unido
17.
AJOB Empir Bioeth ; 11(3): 148-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369433

RESUMO

Background: The COVID-19 pandemic has highlighted health care systems' vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians' discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.


Assuntos
Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Pneumonia Viral/terapia , Padrão de Cuidado , Suspensão de Tratamento/ética , Centros Médicos Acadêmicos , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/ética , Medicina de Emergência/normas , Grupos Focais , Humanos , Entrevistas como Assunto , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Qualidade de Vida , Respiração Artificial/normas , Terapia Respiratória/normas , Padrão de Cuidado/ética , Triagem/métodos , Triagem/normas
20.
Rev. bioét. derecho ; (48): 177-191, mar. 2020.
Artigo em Português | IBECS | ID: ibc-192086

RESUMO

Os recentes casos envolvendo a morte de crianças em razão da suspensão do suporte vital, mesmo com a oposição dos pais, demonstram a necessidade de um debate transdisciplinar sobre o conteúdo do princípio do melhor interesse da criança e a extensão dos poderes-deveres decorrentes da autoridade parental. Poderia a morte, em determinadas situações, representar o melhor interesse da criança? Partindo dos casos de Charlie Gard e Alfie Evans, este artigo tem por objetivo a busca de parâmetros para a tomada de decisões voltadas à terminalidade da vida infantil. Por meio de uma revisão bibliográfica interdisciplinar, buscam-se fundamentos para confirmar ou refutar a hipótese de que a morte pode ser configurada como o melhor interesse da criança em contextos específicos


Los recientes casos que involucran la muerte de niños en razón de la suspensión del soporte vital, incluso con la incisiva oposición de los padres, demuestran la necesidad de un debate transdisciplinario sobre el contenido del principio del mejor interés del niño y la extensión de los poderes-deberes derivados de la autoridad parental. ¿Podría la muerte, en determinadas situaciones, representar el mejor interés del niño? A partir de los casos Charlie Gard y Alfie Evans, este artículo objetiva la búsqueda de parámetros para la toma de decisiones dirigidas a la terminalidad de la vida infantil. Por medio de una revisión bibliográfica interdisciplinaria, se buscan fundamentos para confirmar o refutar la hipótesis de que la muerte puede ser configurada como el mejor interés del niño en contextos específicos


The recent cases involving the death of children due to the suspension of life support, even with the strong opposition of their parents, demonstrate the need for a transdisciplinary debate on the content of the principle of the best interests of the child and the extension of the powers-duties arising from the parental authority. Could death, in certain situations, represent the best interest of the child? Based on the cases of Charlie Gard and Alfie Evans, this article aims to search for parameters for the decision-making in situations of terminally ill infants. Through an interdisciplinary bibliographical review, it is sought the confirmation or refutation of the hypothesis that death can be configured as the best interest of the child in specific contexts


Els recents casos que involucren la mort de nens a causa de la suspensió del suport vital, fins i tot amb l'enèrgica oposició dels pares, demostren la necessitat d'un debat transdisciplinar sobre el contingut del principi del millor interès del nen i l'extensió dels poders-deures derivats de l'autoritat parental. Podria la mort, en determinades situacions, suposar el millor interès del nen? A partir dels casos Charlie Gard i Alfie Evans, aquest article objectiva la recerca de paràmetres per a la presa de decisions dirigides al final de vida infantil. Per mitjà d'una revisió bibliogràfica interdisciplinària, es pretèn confirmar o refutar la hipòtesi que la mort pot ser configurada com el millor interès del nen en contextos específics


Assuntos
Humanos , Masculino , Lactente , Direito a Morrer/ética , Suspensão de Tratamento/ética , Futilidade Médica/ética , Assistência Terminal/ética , Cuidados Paliativos na Terminalidade da Vida/ética , Tomada de Decisão Clínica/ética , Direito a Morrer/legislação & jurisprudência , Eutanásia Passiva/legislação & jurisprudência , Doente Terminal , Morte , Direitos do Paciente/ética , Suspensão de Tratamento/legislação & jurisprudência , Assistência Terminal/legislação & jurisprudência , Poder Familiar , Direitos Humanos/legislação & jurisprudência , Cuidados Paliativos na Terminalidade da Vida/legislação & jurisprudência
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