Essential Ethics

In any paediatric hospital on any given day children are held in order to perform clinical procedures such as taking bloods or X-rays or putting in an intravenous line for fluids. This is done for the safety of all involved and to enable clinically necessary interventions to be undertaken. However, we know that holding children against their will can cause both short and long term harm. We discuss...

Involving the family in the care of a child in hospital is a cornerstone of good paediatric practice. This is realised by encouraging parental presence and participation in care in hospital, and through open communication and shared decision making between clinicians, parents, and the child where appropriate. However, the community and hospital restrictions which came into force during the COVID-1...

Moral distress occurs when an ethical wrong is perceived to be occurring, or has occurred, which a clinician feels powerless to change. We discuss a hypothetical clinical case to explore the experience of moral distress in nursing. How do you recognise moral distress, and, more importantly, what can you do about it? Host: Prof John Massie, Clinical Bioethics Centre, RCH. Guests: Ms Peisha Johnson,...

In paediatric care, nurses are faced with everyday ethical decisions that impact them and their patients. Whether it’s resolving conflicting views about treatment, disclosing diagnostic results to parents, or determining care priorities, all test personal and professional values. An understanding of ethics can help navigate these often murky waters. We explore some common scenarios and reflect on...

The session considers some case examples where ‘deciding with children’ isn’t ethically straightforward. When parents exclude an adolescent from being involved, or when parents disagree with their child’s views, clinicians must decide when and how to advocate for a child to decide. When and why ought they to defer to the parent’s views? Professor Lynn Gillam (Academic Director of the Children’s Bi...

In part 3 of the conference wrap-up, we hear a fascinating concluding presentation from Professor Clare Delany, Clinical Ethicist at The Royal Children’s Hospital and Peter McCallum Cancer Centre. Clare challenges the audience to consider the child’s ability to participate in their medical decision-making in the context of socio-cultural theory of cognitive development. She sets the presentation i...

Professor Lynn Gillam, Academic Director of the Children’s Bioethics Centre at The Royal Children’s Hospital explores what decision-making really is and what it looks like – the various models of shared decision-making that are often used in the healthcare context, who shares the authority to make medical decisions for children, and when does the child’s voice count? With her usual clarity of thou...

Clinical Director of the Children’s Bioethics Centre, Professor John Massie, summarises some of the key messages and critical reflections on how clinicians can decide ‘with’ children in the paediatric environment. What does it really mean to seek and consider the child’s view, and what happens when you’ve asked them, and then don’t do what they want?

This session explores the challenges of respecting a child’s privacy in the age of social media. The phenomenon of ‘sharenting’, whereby parents share news and images of their child on social media is becoming increasingly common among families where children have chronic illness and disability, and some families manage a public social media account dedicated to their child’s medical journey. This...

Professor Douglas S. Diekema (Director of Education for the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Research Institute) opens the Conference by considering the ethical underpinning of the conference theme, ‘Deciding with Children’. Deciding with Children is more than a vague abstraction or aspirational goal of children’s healthcare workers. Prof Diekema demonstrates that...

We explore ways to involve children and young people when managing their chronic condition, using type 1 diabetes as an example. How do the small decisions that respect the child’s preferences and values build towards an independent decision-maker? Given the level of responsibility that parents feel for the outcomes of their child’s disease control, what role does a parent have in deciding with ch...

This session considers what deciding with children looks like when a child has cancer. In this one we try to operationalise deciding with children. We explore ways to engage younger children in their medical decision-making and consider what types of decisions children with cancer can be encouraged to make for themselves. How serious would a decision need to be for the treating team to go against...

This episode explores how clinicians currently involve adolescents in their medical decision making, and how they should involve them. We unpack the tricky transitory space that exists between deciding for younger children, to deciding with these young people who have an increased capacity for reasoning, weighing choices and decision-making. We also consider how far paediatricians should go to pro...

This time focusing on involving young children and early adolescents in medical decision making, we explore the transition from deciding for children to deciding with children. We consider child development and neurobiology, what things are important to children, what we can offer in terms of choices and what to do if we have to override a child’s preference or decision. We also explore decision-m...

We analyse the Gillick decision from the UK with regard to adolescent medical decision-making and the concept of the ‘mature minor.’ We discuss the legal aspects of ‘Gillick competence’ and consider the limitations of the Gillick decision in ethical and practical terms. Finally, we consider alternative framings of adolescent medical decision-making. Host: Prof John Massie. Guests: Annabelle Mann,...

In this podcast we explore the ethical underpinnings of deciding with children when providing medical care. We recognise that children of all ages have varying levels of capacity to understand and participate in medical decisions that affect their own bodies. We cover the following ethical principles in our exploration of deciding with children: the intrinsic and instrumental value of asking and c...

Speakers: Prof David Archard - Chair Nuffield Council on Bioethics, UK and Dr Joe Brierley - Chair, Clinical Ethics Service and Intensivist, Great Ormond Street Hospital for Children, London. This session is a fascinating debate in which Prof Archard advocates for the immediate needs of the sick child in intensive care now, while Dr Brierley insists that medical care for children, even if they are...

Speakers: Prof David Archard - Chair Nuffield Council on Bioethics, UK; Dr Joe Brierley - Chair, Clinical Ethics Service and Intensivist, Great Ormond Street Hospital for Children, London; Dr Sarah Aylett - Clinical Ethics Service and Neurologist Great Ormond Street Hospital for Children, London. In this session we discuss how innovative therapies should be considered for use in the COVID-19 pande...

Speakers: Professors Lynn Gillam and Clare Delany, Children’s Bioethics Centre, RCH and Associate Professor Helen Irving, Clinical Lead for Children Health Ethics and Law, Queensland Children’s Hospital. In this session, the initial consideration is safety to hospital staff in the COVID-19 pandemic, and what might constitute acceptable risk to those staff of becoming infected at work. This opens t...

Speakers: Professors Dominic Wilkinson and Julian Savulescu, from the Uehiro Centre for Practical Ethics at Oxford University, UK. Moderator: Professor David Isaacs, Clinician-ethicist and infectious diseases physician, Children’s Hospital, Westmead, Australia. In this session, Prof Savulescu accepts the premise that a safe COVID-19 vaccine is developed and brings a consequentialist approach to ju...

Speakers: Professor Dominic Wilkinson and Professor Julian Savulescu, both from the Uehiro Centre for Practical Ethics at Oxford University, UK. Moderator: Professor David Isaacs, Clinician-ethicist and infectious diseases physician from the Children’s Hospital, Westmead, Australia. In this session Prof Wilkinson presents arguments in favour of COVID-19 challenge trials, arguing that we have an ob...

Professor John Lantos, Bioethicist and Neonatologist at Mercy Hospital for Children, Kansas City Missouri considers the many ethical dilemmas in clinical care raised by the COVID-19 pandemic and how we can learn from these for post-pandemic times. This is a far-ranging session considering surge management, staff infection, innovative therapies and research.

The Ethics Toolkit is a series within Essential Ethics designed to give clinicians a clear understanding of the tools that bioethicists use to think through complex problems. In this episode we explore the ethical foundations of child and family centred care. The conversation considers the obligations of healthcare providers to involve patients and families in their own healthcare and in designing...

The Ethics Toolkit is a series within Essential Ethics designed to give clinicians a clear understanding of the tools that bioethicists use to think through complex problems. In this episode we discuss what shared decision-making means and consider the ethical principles that underpin it. We then consider how this should include children and adolescents as emerging decision-makers. Host, Prof John...

The Ethics Toolkit is a series within Essential Ethics designed to give clinicians a clear understanding of the tools that bioethicists use to think through complex problems. This episode looks at the Zone of Parental Discretion (ZPD) which is a protected space in which parents can make medical decisions for their children that may not be optimal (best interests) but are not substantially harmful...