J.Jpn. Surg. Soc.. 118(3): 286-293, 2017

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Feature topic

CLINICAL ETHICS IN PEDIATRIC SURGERY

Rapid advances in medical technology including pediatric surgery have improved the survival rates of newborns and children with incurable diseases and have made cure possible in more cases. On the other hand, medical technology is now able to prolong semi-eternally the life of terminal patients with poor prognoses through mechanical interventions such as ventilators. This means that the course of life and death is not natural but artificially controlled by medical technology. In this situation, the following major ethical dilemma can occur in different medical specialties: “How long should invasive interventions, which may be a form of injury, without the patient’s consent be continued?” In Japan, basic education on clinical ethics and palliative care has not been introduced in medical schools, and discussions on end-of-life care with patients’ families are not always held in practice. In Western countries, basic ethical education has been introduced, and decision-making on withholding or withdrawing invasive treatments is shared. The choice of palliative care may lead to academic research on end-of-life care and grief counseling. The main ethical theme should be how to support children with poor prognoses as completely as possible by multidisciplinary medical teams.

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