Pediatric Bioethics

Pediatric Bioethics — What Sets It Apart 

Key Principles

1. Autonomy vs. Parental Authority
   Children’s ability to make informed decisions develops over time. Parents and clinicians must weigh this evolving autonomy against what they believe is in the child’s best interests .

2. Consent vs. Assent
   Legal consent typically isn’t possible before age 18. However, ethically, children should be invited to express agreement (assent) in a way they can understand.

3. Adolescent Decision-Making
   Adolescents have emerging autonomy. In some jurisdictions—under the mature minor doctrine or via Gillick competence—they may be legally empowered to make medical decisions independently

Pediatric Bioethics Dilemma Questions

1. Vaccine Refusal by Parents
   What ethical actions should be taken when parents refuse a recommended vaccination for their child? Consider the risks to the child and community, and the impact on the provider–parent trust.
   
   

2. Adolescent Confidentiality – Pregnancy Disclosure
   A 14-year-old requests that her parents not be informed about her positive pregnancy test. Should the provider respect her confidentiality, and under what circumstances?
   
   

3. Cultural Beliefs & Folk Illness (Empacho)
   How should healthcare providers respond when parents attribute their child’s symptoms to a cultural concept (like "empacho") not recognized in mainstream medicine? What ethical considerations come into play?
   
   

4. The Famous Charlie Gard Case – Best Interests vs. Experimental Treatment
   If parents request an experimental treatment of unproven benefit for their critically ill infant, but the medical team considers it futile, who gets to decide—balancing professional recommendation, parental wishes, and legal authorities? 

5. “Ashley Treatment” – Growth Attenuation in a Developmentally Disabled Child
   Is it ethically permissible to use medical interventions, such as growth attenuation (hysterectomy, hormone therapy), intended to ease care for a profoundly disabled child but that eliminate her bodily autonomy irreversible?