Ethical Issues in Pediatric Neurosurgery Practice: The Neurosurgical Point of View

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Ethical Issues in Pediatric Neurosurgery Practice: The Neurosurgical Point of View

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 10, Issue 4

Abstract

Although there is no one definition of the term ethics, in general, it encompasses the various approaches to understanding and examining moral behavior. The study of ethics can be broadly classified into two areas: Normative and non-normative ethics. Normative ethics seems to answer the question, “What ought I do' for a given moral dilemma, whereas non-normative ethics simply describes how people reason and act in moral situations, without commenting on the inherent 'rightness' of their actions. The application of these principles to health care is a relatively young field. It seeks to define, analyze, and guide decision-making in medicine, as it relates to the moral issues that confront both health care providers and patients. The last four decades have seen tremendous growth in the field of biomedical ethics- there is little doubt that the proliferation of ethics teaching has resulted in a heightened awareness of ethical issues and dilemmas in medicine. There is perhaps no other specialty in medicine that is confronted with ethical quandaries on a daily basis more than pediatric neurological surgery. From severe congenital nervous system malformations, to premature new borns, to quality- of-life and end-of-life issues, pediatric neurosurgeons make medical decisions with profound ethical, spiritual, and religious consequences on an ongoing basis. The root of bioethics date back to the fifth century BC when Hippocrates codified his musings on how a physician should act into the Oath of Hippocrates. The modern resurgence of bioethics occurred in the late 1940s. The Doctors' Trials in Nuremberg from 1946 to 1947 resulted in the formulation of the Nuremberg Code, outlining a list of requirements for the ethical conduct of human-subjects research. The Nuremberg Code has been largely replaced by the World Medical Federation’s Declaration of Helsinki, last revised in 2002. In both the teaching of bioethics and the application of bioethics to clinical medicine, many ethicists use a variety of ethical frameworks-specific lenses through which a particular ethical issue can be seen- to better outline the crux of the ethical matter at hand. Respect for Autonomy The concept of autonomy has superseded the tradition of beneficent paternalism, where patients essentially trusted that their physicians would make appropriate decisions, medically and ethically, on their behalf. Autonomy is the core of the concept of informed consent, in that a person cannot make a truly autonomous decision without fully understanding the risks, benefits and alternatives to the proposed therapy. Pediatric neurosurgeons deal with the difficulties associated with the concept of autonomy in that many of our patients, by virtue of their age, disease, developmental status or statutory restrictions do not have the ability to make decisions on their own, and as such, we must rely on substitute decision makers, in most cases their parents. A common criticism of Western bioethics is the perceived overemphasis on the principle of autonomy. Nonmaleficence Primum non nocere or 'first do not harm’, based on Hippocratic principles, effectively summarizes the principle of nonmaleficence. Virtually any intervention in medicine in general, and perhaps more so in neurosurgery in particular, carries with it the potential to do harm; therefore, it may be better to express the principle of nonmaleficence in terms of undue risk of harm or intent to harm. The principle of nonmaleficence and the importance of intent are often cited when contrasting withholding versus withdrawing treatment and killing versus letting die.

Authors and Affiliations

Dimitrios Panagopoulos

Keywords

Microorganisms Mineralization Ulcers Gypsum Fluoride Intoxication Enamel Systemic Fluoride Absorption Re-Mineralizing Dental Fluorosis Lesions

EP ID EP587300
DOI 10.26717/BJSTR.2018.10.001993
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