Bioethical decision‐making in pediatrics diverges from similar decisions in other medical domains because the young child is not an autonomous decision‐maker, while the teen is developing—and should be encouraged to develop—autonomy and decisional capacity. Thus the balance between autonomy and beneficence is fundamentally different in pediatrics than in adult medicine. While ethical dilemmas that reflect these fundamental issues are common, many pediatric physician and nursing training programs do not delve into the issues or offer specific training about how to deal (...) with borderline cases.To meet this need, the Children's Mercy Bioethics Center in Kansas City, Missouri, created a program specifically dedicated to serving practicing, experienced pediatric health professionals. Our students come from various professional disciplines: they are doctors, nurses, social workers, chaplains, lawyers, psychologists, counselors, and hospital administrators practicing in pediatrics. (shrink)

As Josie's physicians, we developed trusting relationships with the family, relationships based on honesty. When their daughter passed away a week after the conversation described, at least we had not sheltered them from that possibility but prepared them for it. We continue to wonder, however, what words parents are hearing that we do not intend for them to hear. In addition, we wonder what words they are hearing that do not truly mean what they imply? How can health care providers (...) caring for patients and families recognize that simple words like “good,” “stable,” and “quiet” may be misinterpreted and may affect the trust families place in our communication? As for us, we choose our words more carefully now. (shrink)

On a recent evening, while working in a children's hospital emergency department as a pediatric emergency medicine physician, I picked up the chart of yet another patient without a true emergency: a sixteen-year-old with vaginal discharge. After reviewing her chart, her nurse and I spoke with her in her room. Her story was all too familiar. She was sexually active. She did not use contraception. She had also been treated for pelvic inflammatory disease three times before, but luckily, she had (...) not yet been pregnant. And like many adolescents, she did not have a primary care physician, so the emergency department was her primary care clinic. I informed her that she would need a pelvic exam and a pregnancy test. I .. (shrink)