‘Children are not small adults’—the distinctiveness of ethics in children

Clinicians working in paediatric palliative care encounter many of the same practical ethical quandaries that face colleagues working in the adult specialty. While the underlying moral principles must be the same, their application to children is often distinctive and ethics is an illustration that ‘children are not small adults’. The key ethical test is the child’s interests; the benefits that an intervention will offer relative to its harms. Establishing them, however, is often not straightforward, and there is a risk that interests become abstracted from the context of a caring relationship that defines the state of being a child. In this chapter we consider a number of specific challenges in paediatric ethics at the end of life: the source of authority in medical decision making, ethics of research in children, collusion (especially in older children and young adults), the principle of double effect (PDE), and euthanasia.