Indian Doctors Devise Ethical Norms for Pediatrics

Healthcare intervention for toddlers and adolescents should match a child's casual reasoning, language ability and self-understanding, says a module developed by two Indian doctors that has been accepted by the International Paediatric Association (IPA).

This will also help in making correct clinical assessment of a young patient's condition, say the guidelines formulated by Jaipur-based paediatrician Ashok Gupta and New Delhi-based Swati Bhave. "The module has underlined the significance of communication in paediatric practice to address children's concern about separation from parents, family and in an unfamiliar environment," Gupta told IANS.

The module is a first for the Geneva-based IPA, which has 140 countries as its members. It covers a wide array of ethical norms that are not mandatory but may be followed, especially during dilemmas faced by paediatricians in case of life-threatening situations for patients.

The IPA governing council approved the draft module at its meeting held in Athens recently. Gupta, who is also president of the International Society of Tropical Paediatrics, said motivational interviewing had emerged as an effective method for fostering rapport with both children and their parents.

Children actively participating in this therapeutic alliance demonstrate greater reception to treatment. The module, while pointing out that no single intervention is likely to be effective from early childhood throughout adolescence, said it was important to understand the influence of social environment, family, peers, school and the larger community on a child.

As adolescents develop coherence in their beliefs and values while asserting greater independence from parents, they should be included in the intervention efforts and the parental involvement should be restricted.

However, parent-directed behavioural intervention should be adopted to reduce distress and pain associated with routine immunisation, dental treatments and burn treatments. The deep-breathing distraction techniques could also reduce distress levels among young children, said the module. The module recognised the moral and legal authority of parents to make healthcare decisions for their children and pointed out that pain relief was an emerging legal and ethical frontier of medicine.

It said a structured protocol should be followed for all children who receive sedative medications and family presence should be offered as an option during painful procedures.

Dealing with the arduous task of delivering "bad news" to the parents, the module said if handled improperly, it could result in long-term emotional consequences for the family. "Paediatricians should use their interpersonal skills while facing this predicament and make an attempt to console the parents," said Gupta.

The module advocates respect for informed consent and the right to refuse treatment, but added that the decision-making involving the health care of young patients should flow from the responsibility shared by physicians and parents.

Ethical conflicts in this regard should be resolved in the best interest of the child.

Source-IANS
LIN/V