Between technique and virtue: a bioethical reflection on the management of patients with anorectal malformations

Anorectal malformations (ARM) present complex clinical and ethical challenges that extend from neonatal surgical decision-making to long-term functional rehabilitation. This review explores three bioethical issues that emerge in the care of patients with ARM: first, the application of Beauchamp and Childress's principles of biomedical ethics to surgical management and rehabilitation; second, the identification of an ethical framework to navigate the intersection between clinical and ethical decision-making in rare diseases; and third, the ethical challenges related to acquiring professional competence in the management of complex pediatric surgical conditions. We argue that virtue ethics and medical professionalism complement Beauchamp and Childress's principles by providing practical guidance for pediatric surgeons facing difficult decisions throughout the continuum of care. This review offers a bioethical framework for addressing clinical decision-making and questions regarding professional competence in ARM. It highlights the role of bioethics in promoting patient safety, professional accountability, and responsible professional development.