Family Centered Bioethics: A New Bioethical Framework for Decision-Making in Neonatal and Pediatric Units

Gonzalez-Melado Fj,Teleman Aa

doi:10.4172/2155-9627.1000263

Abstract

Pediatric bioethics emerged from the transfer of the framework of bioethical reflection on adult competent patients, which focuses on the principle of autonomy, to minors and incompetent patients. However, we believe that the framework of patient autonomy is not appropriate for pediatric bioethics and propose a new framework based on the moral responsibility of parents and health care professionals towards the needs of the sick child. The essential elements in creating a new framework for pediatric bioethics are: the primacy of the principle of beneficence, over the principle of autonomy; the therapeutic alliance as an affective and genuine union between the physician, child patient and parents; the therapeutic intentionality as the engine of this alliance; and finally, a real family centered care. These elements establish the bioethical framework of neonatal and pediatric units, by integrating the child’s interests within the family’s, and permits us to propose an authentically family-centered bioethics.

Highlights

Pediatric bioethics emerged from the transposition of the framework for the reflection on adult competent patients, which focuses on the principle of autonomy, to the reflection on minors and incompetent patients [1]
If we analyze pediatric bioethics starting from the principle of autonomy, the only possible standard becomes the child’s best interest [2], since its origin has been associated with the evaluation of treatments through the concept of expected quality of life (QL) [3] and has been widely criticized [4] and reformed [5]
We should move from a triangular picture representing the relations between the medical team, child and family, which is characteristic of a pediatric bioethics based on autonomy, to a circular image, in which the child is placed in the center (Table 1)

Summary

A New Framework for Pediatric Bioethics Reflection

Pediatric bioethics emerged from the transposition of the framework for the reflection on adult competent patients, which focuses on the principle of autonomy, to the reflection on minors and incompetent patients [1]. The doctor is the last guardian of the patient’s life and health [18] This is the moral responsibility that allows the physician to act against the will of the parents, if they are putting at risk the best interest of the child [22]. The physicians’ professional responsibility in pediatrics should be guided by the rule of mediated beneficence, requiring physicians to be able to coordinate their commitments for the welfare of the patient, with the opportunities and limits that are given by the needs of the patient, and the context and preferences of the child’s family. The health professional must establish a therapeutic alliance with the patient’s parents or guardians This alliance includes, among its responsibilities, the necessity to protect the present and future interests of the child and its family [9]. Medical pediatric paternalism must be the exception rather than the rule, and medical care in pediatrics should ideally be centered on the entire family

A Family Centered Care

Conclusion