Is there a particular pediatric otolaryngology ethic?

Abstract

Objectives: This paper proposes that there is a specific pediatric otolaryngology ethic.

Methods: In support of this contention, traditional ethical frameworks are considered, before ethical issues specific to pediatric otolaryngology are addressed.

Results: First, there is a difference between child flourishing and family flourishing, parents have parental virtue (as parents), and where autonomy as a moral agent is vested, is contested. Parents act as both proxy decision-makers and as autonomous decision-makers for our patients. We are aware of the open future of a child. We worry about unvoiced and unvoicable concerns and distress in children. Second, we treat the not-yet-born and the recently born, so we need a philosophical understanding of what is a person, and when we become one. Third, traditional approaches to decision-making in medical ethics in Western settings are based upon the frameworks of duty and rules, or of consequences and outcomes, or are virtue-based. In our contemporary era, characterized by pronounced value pluralism, these ethical approaches no longer provide sufficient guidance in the complex milieu of our pediatric otolaryngology practice. In contemporary pediatric otolaryngology, a moral philosophical approach is needed to add meaning and normativity (a sense of oughtness or shouldness) to decision-making amongst the stakeholders in the clinical consultation.

Conclusion: Determining the virtuous balance between a priori rules and empirical consequences is a possible solution. This is put into clinical practice via the process of dialogic consensus - an inclusive, non-coercive and reflective dialogue, aimed at reaching a consensual decision as how to maximize the good of our young patients and their family. Based upon differing ethical and moral considerations, and specific issues around children and their families, there is a particular pediatric otolaryngology ethic.

Keywords: Dialogic consensus; Ethics; Morals; Pediatric otolaryngology.