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MARCH 2004

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.#

 

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