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[Translated article] Ethical approach to pain management in pediatric patients in a terminal situation: A systematic

Cristina Casanova-Martínez1, Mónica Gayoso-Rey2

  • 1Servizo de Xestión da Prestación Farmacéutica, Subdirección Xeral Farmacia, Dirección Xeral de Asistencia Sanitaria, SERGAS, Consellería de Sanidade, Santiago de Compostela, Spain.

Farmacia Hospitalaria : Organo Oficial De Expresion Cientifica De La Sociedad Espanola De Farmacia Hospitalaria
|December 13, 2025
PubMed

Insights

This systematic review highlights ethical challenges in pediatric palliative pain management. Inconsistent application of bioethical principles, like autonomy and justice, affects care for terminally ill children.

Area of Science:

  • Bioethics
  • Pediatric Palliative Care
  • Pain Management

Background:

  • Pediatric palliative care focuses on terminally ill children's needs, with pain management as a key component.
  • Ethical considerations are crucial in end-of-life care for children.

Purpose of the Study:

  • To systematically review ethical aspects of pain management in pediatric palliative care.
  • To analyze pain management through the lens of bioethical principles: autonomy, beneficence, non-maleficence, and justice.

Main Methods:

  • Systematic review following PRISMA guidelines.
  • Inclusion of qualitative/quantitative studies (2010-2024) in English/Spanish on pediatric palliative pain management ethics.
  • Databases: PubMed, Scopus, Web of Science; Quality assessment: MMAT.

Main Results:

  • 18 studies included. Limited child autonomy, often via caregivers.
  • Beneficence/non-maleficence compromised by underuse of analgesics and futile treatments.
  • Justice issues include access barriers to opioids and specialized care, especially in resource-limited settings.

Conclusions:

  • Bioethical principles are inconsistently applied in pediatric end-of-life pain management.
  • Need for enhanced professional training and standardized protocols.
  • Improved communication with families is essential for ethical care.
Abstract

Keywords:
DolorEthicPainPaliativoPalliativePediatricPediátricoÉtica

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