This document discusses the ethical and legal aspects of pediatric surgery. It begins by stating that ethics, surgery, and law are interrelated, with ethics guiding what we should do and law dictating what we must do. It then discusses the core principles of medical ethics - beneficence, non-maleficence, autonomy, and justice. Key issues in pediatric surgical ethics that are examined include informed consent, confidentiality, and research. The importance of maintaining excellent surgical standards, disclosing errors to patients, and respecting patient autonomy are also emphasized. Throughout, the document stresses that pediatric surgeons must practice according to strong ethical principles in order to best serve their patients.

1. ETHICAL AND LEGAL
ASPECTS OF
PEDIATRIC SURGERY
Dr Roshan Kumar Shah
Phase A ( Resident )
Department Of Paediatric Surgery

2. Special Thanks to
Dr. Md.Nooruzzaman
Assistant Professor
Dept. of Pediatric Surgery

3. Learning Objectives
• Definition of ethics
• Identify the issues
• Explanation of Issues
• How to do better practice in paediatric surgery

4. Introduction
 Surgery, Ethics and Law go hand in hand.
 Ethics tells us what we ought to do but
law stipulates what we must do.
 The breadth of paediatric surgery from
prenatal consultations to surgery in young
adults exposes the paediatric surgeon to a
variety of ethical concerns.

5.  The pediatric surgeon should be prepared to deal with the
different ethical issues that are integral to this broad spectrum
of clinical encounters.

6.  Pediatric surgeons are often confronted with clinical situations
that involve decisions about the continuation of life-sustaining
treatments for infants and children with critical illness.
 These difficult issues fall within the basic social commitment
that defines the professional obligation of physicians to sustain
life and relieve suffering.

8. History
 The Hippocratic Oath defines the ethical principles guiding
medicine, instructing physicians to use their knowledge and
skills for the benefit and protection of their patients.

9. Definition
The word “ethics” derived from a Greek word ethos which
means “character.”
Ethics means what is good for individual and for
society and also establishes the nature of obligations or
duties.

10. Surgical Ethics
 Ethics is an essential discipline in the practice of surgery
 Represent your best understanding of moral
responsibility
 Evolves as reasoned reflection on clinical experience
 Ethical studies investigate what should be our character and
conduct.

12. Principles of Medical
Ethics

13. Four major principles-
1. Beneficence: physician to do and promote good
2. Non maleficence: cautious physician “to do no harm”
3. Autonomy: respects the right of competent persons to
give informed consent for medical treatment and to
have control over their bodies
4. Justice: Fair and equitable distribution of medical care
to all persons.

14. Issues in paediatric surgical ethics
• Autonomy
• Informed consent and difficulties
• Confidentiality
• Research in paediatric surgery
• Excellent standards

15. Autonomy
 Respect autonomy of patient and their ability to make
choice about their treatment
 It recognizes right of patient to self determination
 So patient have right to make choice over their surgical
care .

16. Practical Difficulties
Sometimes there is conflict of principles of autonomy and
beneficence .

17. Attention
 Counseling
 Clarifications of Doubts
 Explanations of risks and benefits
 Avoidance of technical language

18. Informed consent
 Respect of autonomy is the basic of informed consent
 It is the fundamental things on which the morality and legality
of good surgical practice depends.
 In case of paediatric patient he or she cannot give the consent,
so parents has the right to give consent

19. General components of informed
consent
• Details about the diagnosis and prognosis
• Options for management of the condition
• Risks and benefit for each treatment option
• A detail explanation of the proposed procedure
• Side effects and probable complications

20. Consent form
 Should be written
 Signed by the parents < 16 years
 Signed by the patient > 16 years

21. Consent in special situation
 Unconscious patient : Surgeon as proxy
 Emergency situation : No need of informed consent to
save life, but keep a good record of the situation
 Mentally handicapped or psychologically upset
 Substance abuse
 Sexually abused

22. End of Life Issues ..
In Unusual circumstances( close to death ), no evidence
shows that a specific treatment desired by the patient will
provide any benefit from any perspective , the physician
need not provide such treatment.

23.  If there are no treatment options i.e, the patient is brain dead
but the family insists on treatment, there is nothing that the
physician can do, so treatment must be stopped.

24. Confidentiality
 The principle of confidentiality is that the information of a
patient/legal guardian reveals to a surgeon is private and has
limits on how or when it disclose to the third party.
 Breaking confidentiality
- if the patient is threat to self or others
- to other team members to improve the treatment options.
- public interest and court order.

25. Surgical Error
 Patient undergo serious harm from a surgical error that
prolong their hospitalization, causes unnecessary suffering,
and increase the cost of care.
 Common examples of error include wrong diagnosis, wrong
patient ( or site ), procedure, and retained foreign bodies.

26. Good standards
To optimize success in protecting life and health to an
acceptable standard:
Paediatric surgeons must only offer specialized
treatment in which they have been properly trained.
To do so , further education and training through out a
surgeon’s career is necessary.

27.  When a surgical error has occurred, surgeon should
proceed to inform the patient and parents in clear
language about the nature of the error, the anticipated
consequences, and how the error will be managed in
time.
Issue Regarding Errors..

28.  To the contrary, failure or inadequate disclosure of errors
might increase parents anger and mistrust, thereby increasing
the likelihood of lawsuits.

29. Take home message
 Every surgeon should practice ethical & legal aspect of
Surgery to protect himself and to respect human rights.
 No one solution for all.

30. References
 Bailey and Loves- short practice of surgery, 27th edition
 Pediatric surgery-Arnold G. Coran, 7th edition
 ASHCRAFT’S Pediatric surgery, 6th edition