Who decides? Patients, parents, or gatekeepers: pediatric decisions in the craniofacial setting

Area of Science:

• Pediatric Ethics
• Craniofacial Surgery
• Medical Decision-Making

Background:

• Pediatric craniofacial care presents unique ethical dilemmas.
• Surrogates, typically parents, make medical decisions using the 'best interests' standard for children.
• Craniofacial teams serve as gatekeepers in pediatric medical decision-making.

Observation:

• Children's participation in decisions should increase with their abilities, especially for elective procedures.
• Financial considerations increasingly impact medical choices for pediatric patients.
• The craniofacial team's primary ethical obligation is to the child patient.

Findings:

• Ethically sound practice requires weighing intervention risks and benefits.
• Facilitating family and patient discussions to define 'best interests' is crucial.
• Monitoring patient outcomes and advocating for patients are key responsibilities.

Implications:

• Developing care guidelines and defining basic care levels can aid decision-making and advocacy.
• Ethical analysis is integral to quality patient care and effective policy development.
• Integrating ethical considerations into regular team deliberations is essential for responsible craniofacial care.