Tag Archives: pediatric ethics

Aggressive Interventions for an Infant with Thanatophoric Dysplasia

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Question: What medical and surgical treatments should be offered to an infant with a birth diagnosis that portends a lifetime of chronic problematic therapeutic needs?
History:

Chelsea is a 7-week-old girl with thanatophoric dysplasia (TD) who has had a long and tumultuous hospital course since birth. Her diagnosis was discovered on prenatal ultrasounds, and her parents met with pediatric subspecialists, including both neonatology and pediatric palliative care. They received counseling on Chelsea’s diagnosis, its severe lung pathology, and poor survival rates. They discussed possible management and anticipated challenges, including the possibility that Chelsea would not respond to such interventions. The team and the parents focused on the “moment-by-moment” information gathering and decision-making in the delivery room, only briefly touching on the inevitable long-term support needs if Chelsea survived. Despite the counseling the parents received, they felt as if a trial of resuscitation was in Chelsea’s best interests after birth.

Ten Critical Ethical, Conceptual, and Clinical Cautions Concerning the Diagnosis and Treatment of Gender Dysphoria and Transgender Identification

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Abstract

There is an urgent need for ethical, conceptual, and clinical clarity regarding the diagnosis and treatment of gender dysphoria and transgender identification. In this essay, I highlight ten critical concerns in this arena, namely, those involving: (1) conceptual parallels between sexual reassignment surgery and elective limb amputation; (2) the lack of long-term data that demonstrates reliable long-term relief from gender dysphoria in those undergoing hormonal or surgical treatment for gender dysphoria; (3) special problems with informed consent in the context of “gender affirming” treatments; (4) the importance of very high desistance rates of gender dysphoria and transgender identification, particularly in children, even without treatment; (5) the extensive differential diagnosis and the need for thorough and subtle assessments in the face of gender-related complaints; (6) a deep religiously based objection to transgender ideology involving the ordering of creation; (7) controversies concerning the existence of rapid-onset gender dysphoria; (8) the recent depathologizing of gender dysphoria; (9) the roles of genetics and environment in transgender identification and gender dysphoria; and (10) reflections on the role of psychotherapeutic treatment in patients with gender dysphoria and transgender identification.

Keywords: transgenderism, gender dysphoria, transsexualism, sexual reassignment surgery, gender affirming care

Religious Decision-Making in a Teenager

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Question: May we accept this adolescent Jehovah’s Witness refusal of blood transfusion?
In this case, the physician needs to ascertain whether or not a teenager’s statement of religious faith should be allowed to direct her life-sustaining medical treatment.

Keywords: Jehovah’s Witness, Mature Minor Doctrine, Blood Transfusion Refusal, Decision-Making Capacity, Adolescent Autonomy, Pediatric Ethics, Medical Jurisprudence

A Legal Comment

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O.R. Johnston’s article canvasses many of the varied issues, ethical, medical and legal arising from the decision in Gillick V. West Norfolk and Wisbech Area Health Authority. This comment will focus more specifically on some of the legal issues involved.

A General Practitioner’s Response

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As the author of the editorial in the Christian Medical Fellowship Journal to which Mr Johnston refers, it is perhaps not surprising that I am very substantially in agreement with the points that he makes, although we have never communicated personally about this matter. I will seek nevertheless to amplify some of them slightly from a medical view-point.

Doctors and the Gillick Case

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In April this year a letter to the Prime Minister was handed in at 10, Downing Street from some of Britain’s top ‘agony aunts’. Signatories included Katie Boyle, Claire Rayner, Marjorie Proops and Anna Raeburn. They urged the Government not to accede to pressure to rescind the existing guidelines published by the Department of Health and Social Security whereby doctors can provide contraceptive a device without the knowledge of the parents to girls under 16.