Related Experiment Video
Updated: Jun 26, 2025
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Ethical and practical considerations of pediatric refusal in clinical anesthesia: An educational review
J Patrick Haltom1,2, Amy S Martin1
1Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, Indiana, USA.
Insights
Pediatric anesthesia induction often faces refusal. This review guides providers on ethically navigating children's dissent, balancing patient rights with medical necessity.
Area of Science:
- Pediatric Anesthesiology
- Medical Ethics
- Child Psychology
Background:
- Children frequently refuse anesthesia induction, presenting a clinical dilemma.
- Proceeding over objection can involve physical restraint, causing patient-provider harm.
- Ethical and practical considerations arise when children dissent to anesthesia.
Purpose of the Study:
- To explore the practical and ethical challenges of pediatric anesthesia refusal.
- To define and compare terms related to dissent in pediatric decision-making.
- To inform anesthesia providers on navigating these complex situations.
Main Methods:
- Literature review and synthesis of ethical principles.
- Analysis of legal and professional standards in pediatric care.
- Discussion of current practice trends and novel approaches.
Main Results:
- Dissent is clarified as both an ethical and practical concept in pediatric anesthesia.
- Current practices and legal/professional standards are summarized.
- Novel approaches for honoring dissent in elective pediatric surgeries are explored.
Conclusions:
- Anesthesia providers must ethically consider their position within legal and professional boundaries.
- Nuances of pediatric refusal require careful consideration.
- Key questions are posed for clinicians to reflect on honoring dissent during anesthesia induction.
Abstract:
Children commonly refuse induction of anesthesia. Anesthesia providers must then decide whether to honor the child's dissent or to proceed over objection. In some circumstances, a forced induction involves restraining the child, incurring both practical and ethical harms to the patient-provider encounter. This educational review explores the practical dilemma encountered when a child dissents to induction of anesthesia. In the course of exploring this dilemma, dissent and associated terms are defined and compared, and the prominent ethical underpinnings regarding pediatric decision-making are described to clarify dissent as an ethical and practical concept. Important legal and professional standards are summarized, and practice trends are discussed to depict the current state of practice, including novel approaches to honoring pediatric dissent for elective surgeries. This information is then used to invite providers to consider where they ethically situate themselves within a legally and professionally defined space of acceptable practice. Finally, these considerations are synthesized to discuss important nuances regarding pediatric refusal, and some key questions are presented for clinicians to ponder as they consider their practice of choosing whether to honor pediatric dissent at induction.
Related Concept Videos
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:17Ethical Dilemmas I
Let us explore some examples to understand the potentially complex moral decisions nurses face.
Take the case of caring for minors, particularly in areas related to reproductive...
01:30Ethical Dilemmas II
01:08Obedience
01:27Nursing Ethical Principles II
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
01:22Ethics and Bioethics