Virtual Mentor. July 2010

This month in Virtual Mentor

Pediatric Palliative Care

Pediatric palliative care is the medical subspecialty that provides total care for the body, mind, and spirit of a child with an illness—and support for his or her family. The care can begin when a child is diagnosed and continue throughout the illness, whether the outcome is better health or death. The stark ethical concerns in pediatric palliative care range from respecting the developing moral autonomy of the child to effects of the illness on siblings and heartrending decisions to discontinue life-sustaining treatment. Virtual Mentor’s July contributors examine these and other matters with penetrating clarity and compassion.

Pediatric Palliative Care: Born of Necessity David Buxton, MD The topic of children dying is an uncomfortable and, at times, taboo subject in the field of medicine.

“Please Let Me Hear My Son Cry Once” Wynne Morrison, MD, MBE Parents want their child with severe disabilities to be accorded the same respect a healthy child gets, including a physical exam in the ER to diagnose and perhaps treat a minor illness unrelated to his or her impairments.

Do-Not-Attempt-Resuscitation Orders in Public Schools Kathryn L. Weise, MD, MA One argument advanced against having DNR orders in schools for children with life-limiting illnesses is that “doing nothing” traumatizes onlookers because it feels like abandonment of a patient.

What We Don’t Know about How We Decide Chris Feudtner, MD, PhD, MPH We should conduct empirical research to better understand how patients, parents, clinicians, and others grapple with the ethical challenges we confront when caring for children who are dying.

Upcoming Issues

• August Sexual Orientation, Gender Identification, and Patient Care
• September Natural Disasters, Quarantine, and Public Health Emergencies
• October Ethical Issues in Cardiology
• November: Gray Matters: Neuroethics in the Twenty-First Century