Ethical Challenges in Pediatrics
by Joanna R. Leefer
Developments in genetics, reproductive technologies and other
disciplines have brought new challenges in every area of medicine.
This is particularly true in pediatrics. New advances in all
areas of treatments have created complex ethical questions
for the provision of care and for research with children.
The 2004 Conference on Medical Ethics
sponsored by The Mount Sinai School of Medicine’s Institute for Medical Education
focused on the special ethical challenges faced in pediatrics.
The conference, held recently, addressed the ethical use of
children in medical research, the role of parents and culture
in such areas of hormone use and vaccinations, and the ethicacy
of pre-and postnatal screening. The conference was attended
by pediatricians, medical personnel, students, and social workers
at Mt. Sinai’s Hatch Auditorium, in the Guggenheim Pavilion
at 100th Street and Fifth Avenue.
Renowned ethicist, Arthur Caplan,
Ph.D. of the University of Pennsylvania and Dr. Robert Rapaport,
MD of the Mt. Sinai School of Medicine led the discussion
on the uses of growth hormones in children. Dr. Caplan stated
that when hormones were first introduced in 1958, they were
used primarily to treat extremely short children due to the
hormone’s scarcity.
In 1985, a new synthetic growth hormone was developed making
it accessible to less extreme cases. This raises ethical issues
on who should be treated. According to Dr. Rapaport, the average
growth increase for a child on hormones is only about 2 inches
at best while the treatment regiment requires the child take
daily injections over long periods of time. At present there
are no guidelines to determine which children are short enough
to benefit from the treatments or if the results offer a sufficiently
better quality of life.
The topic of genetic screening and
testing was introduced by Dr. Kurt Hirschorn, of Mount Sinai
School of Medicine, and led by Dr. Judith Willner of Mt.
Sinai, Mary Kay Pelias, Ph.D. from LA State University, and
Prof. Rosamond Rhodes, also of Mt. Sinai. Major questions
revolved around who should be tested, and who should have
access to the results. Some genetic testing has been instrumental
in lessening such lethal conditions as sickle cell anemia,
or Tay Sachs. However genetic testing also is available for
pre-determining a genetic disposition. What if testing indicates
a predisposition towards criminal behavior? What about finding
out the predisposition of particular medical conditions such
as cancer, or Alzheimer’s. Should people
be aware of these tendencies and if so can the information
be applied constructively?
Other panelists at the Conference included John Lantos, MD
of the University of Chicago, who led the discussion on the
ethics of continual treatment of cases that seem futile and
Dr. Jennifer Koestler who hosted the discussion on testing
with children.#
