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Physicians, parents, patients, and guardians share a common goal to protect the health and well-being of the child. In the event of a disagreement, every effort must be made to resolve conflicts to assure the best possible outcome for the child.
Informed consent is the appropriate term for the process of reaching an agreement about medical care between a physician and a patient with full decision-making capacity and legal empowerment.
Informed permission is the preferred term when a parent makes decisions for a patient lacking decision-making capacity or legal majority.
Assent (or permission) of the patient is very important and should be sought whenever possible.
Treatment for an emergency medical condition should never be delayed if a patient is unable to provide informed consent or a parent or guardian is not present to provide permission.
Despite a long history in medical education, practicing procedures on the newly dead is problematic. It should only be done with fully informed permission from a parent or guardian.
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Medical ethics is a philosophical discipline that guides medical practitioners to act in the best interests of patients. Ethical conflicts may arise if there are differences of opinion about what those best interests might be. Many different approaches have been explored in detail, and many emergency medicine practitioners approach the discipline from different philosophical, moral, or religious viewpoints.1,2
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Emergency physicians (EPs) are responsible for providing medical care in an increasing fiscally and ethically challenging environment. Emergency care is provided to anyone in need, regardless of immigration status or ability to pay. Emergency departments (EDs) are the only places in the United States where all patients are guaranteed medical care, serving as an essential medical safety net.3 This fundamental dedication to provide care to those most in need or with no other healthcare options is a core ethical value of emergency medicine.2,4
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In the practice of pediatric emergency medicine, patients, parents, guardians, and physicians generally have a common goal: to act in the best interests of the child. The physician has an obligation to diagnose and treat illness, alleviate discomfort, and provide for the quickest and most complete recovery possible. With effective communication, an agreement can usually be reached between the physician, patient and family and a diagnostic, therapeutic, and follow-up plan can be implemented. Rarely, conflicts arise that if unresolved could jeopardize the health and well-being of the child. Significant effort may be required for resolution to provide for the best possible outcome for the child from each party's perspective.
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An EP needs to be familiar with current recommendations, policy statements, principles, and controversies that guide the practice of emergency medicine, as well as the same concepts as they apply to the care of children. This section will focus on the ethical considerations at the intersection of emergency and pediatric medicine.