Ethical and practical considerations of pediatric refusal in clinical anesthesia: An educational review.

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2024-08-01 Epub Date: 2024-05-13 DOI:10.1111/pan.14921

J Patrick Haltom, Amy S Martin

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引用次数: 0

Abstract

Children commonly refuse induction of anesthesia. Anesthesia providers must then decide whether to honor the child's dissent or to proceed over objection. In some circumstances, a forced induction involves restraining the child, incurring both practical and ethical harms to the patient-provider encounter. This educational review explores the practical dilemma encountered when a child dissents to induction of anesthesia. In the course of exploring this dilemma, dissent and associated terms are defined and compared, and the prominent ethical underpinnings regarding pediatric decision-making are described to clarify dissent as an ethical and practical concept. Important legal and professional standards are summarized, and practice trends are discussed to depict the current state of practice, including novel approaches to honoring pediatric dissent for elective surgeries. This information is then used to invite providers to consider where they ethically situate themselves within a legally and professionally defined space of acceptable practice. Finally, these considerations are synthesized to discuss important nuances regarding pediatric refusal, and some key questions are presented for clinicians to ponder as they consider their practice of choosing whether to honor pediatric dissent at induction.

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临床麻醉中儿科拒绝的伦理和实际考虑因素：教育回顾。

儿童通常会拒绝麻醉诱导。这时，麻醉服务提供者必须决定是尊重儿童的反对意见，还是不顾反对继续进行。在某些情况下，强制诱导会涉及到限制儿童的行为，从而对患者和医护人员之间的接触造成实际和道德上的伤害。本教育综述探讨了当儿童对麻醉诱导提出异议时所遇到的实际困境。在探讨这一困境的过程中，对异议和相关术语进行了定义和比较，并描述了有关儿科决策的重要伦理基础，以澄清作为伦理和实践概念的异议。总结了重要的法律和专业标准，讨论了实践趋势以描述当前的实践状况，包括尊重儿科选择性手术异议的新方法。然后，利用这些信息请医疗服务提供者考虑他们在法律和专业界定的可接受实践空间中的道德定位。最后，综合这些考虑因素，讨论有关儿科拒绝的重要细微差别，并提出一些关键问题，供临床医生在考虑是否在诱导时尊重儿科异议时思考。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.