The patient-parent-pediatrician relationship: everyday ethics in the office

Pediatricians and parents generally try to do what is best for children, but they do not always agree about what that is. Mothers and fathers may disagree with each other. Parents may disagree with pediatricians. Disagreements can arise about the goals, nature, and value of communication with children about health information. Disagreements can arise over the value of particular medical interventions. Some disagreements are grounded in different religious beliefs. Some are about moral values. Some are disagreements about ends, others about the best means to an agreed on end. If there is an intractable disagreement and discussion has failed to resolve that disagreement, pediatricians must decide whether to compromise their own values to preserve a therapeutic relationship, sever that relationship, or try to override a parental choice by referring a case to child protection authorities. Most cases can be resolved and a consensus found. This article discusses some common scenarios in which disagreements arise, including home birth, refusal of vitamin K, vaccine hesitancy, birth control for teens, corporal punishment, and surreptitious drug testing.