11
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Evaluation of pediatric residents’ attitudes toward ethical conflict: a cross-sectional study in Tehran, Iran

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Ethical conflicts are recognized as critical aspects in assessing competence in clinical communication. Moreover, pediatrics residents may face more problems, compared to other disciplines; due to the specific characteristics of the age group receiving services as well as the presence of their families. This study has been conducted with the aim of determining the attitude and perspective of pediatric residents toward ethical conflicts in the field of pediatrics. This descriptive, cross-sectional study was carried out on all residents of Tehran University of Medical Sciences (90 residents), selected through census method, in 2014. The data collection tool was a 32-item research-based questionnaire. Its validity and reliability were confirmed by the researchers and the medical faculty members. To analyze data, descriptive and inferential statistics were used. However, based on the results, lack of an advanced directive and written procedure for withdrawing life-sustaining treatment of an incompetent or critically-ill child (4.38 ± 0.80), lack of provision of sufficient information on obtaining informed consent (4.12 ± 1.10), and the absence of a legal written process for doing not resuscitate (DNR) orders (3.98 ± 0.95) were the most salient causes of ethical conflicts in pediatrics. Furthermore, in accordance with the linear regression analysis of demographic characteristics, there was a significant relationship ( P = 0.04, r = 0.046) between residents’ year of education and attitude toward ethical conflict; however, this relationship was not observed in other demographic characteristics. Taking the priorities of ethical conflicts in pediatrics into account may help improve the designing of medical ethics education programs in hospitals for residents, thereby reducing the conflicts related to the issues of medical ethics.

          Related collections

          Most cited references27

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Why is it hard to make progress in assessing children’s decision-making competence?

          Background For decades, the discussion on children’s competence to consent to medical issues has concentrated around normative concerns, with little progress in clinical practices. Decision-making competence is an important condition in the informed consent model. In pediatrics, clinicians need to strike a proper balance in order to both protect children’s interests when they are not fully able to do so themselves and to respect their autonomy when they are. Children’s competence to consent, however, is currently not assessed in a standardized way. Moreover, the correlation between competence to give informed consent and age in children has never been systematically investigated, nor do we know which factors exactly contribute to children’s competence. This article aims at identifying these gaps in knowledge and suggests options for dealing with the obstacles in empirical research in order to advance policies and practices regarding children’s medical decision-making competence. Discussion Understanding children’s competency is hampered by the law. Legislative regulations concerning competency are established on a strong presumption that persons older than a certain age are competent, whereas younger persons are not. Furthermore, a number of contextual factors are believed to be of influence on a child’s decision-making competence: the developmental stage of children, the influence of parents and peers, the quality of information provision, life experience, the type of medical decision, and so on. Ostensibly, these diverse and extensive barriers hinder any form of advancement in this conflicted area. Addressing these obstacles encourages the discussion on children’s competency, in which the most prominent question concerns the lack of a clear operationalization of children’s competence to consent. Empirical data are needed to substantiate the discussion. Summary The empirical approach offers an opportunity to give direction to the debate. Recommendations for future research include: studying a standardized assessment instrument covering all four relevant dimensions of competence (understanding, reasoning, appreciation, expressing a choice), including a study population of children covering the full age range of 7 to 18 years, improving information provision, and assessing relevant contextual data.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Talking with parents about end-of-life decisions for their children.

            Retrospective studies show that most parents prefer to share in decisions to forgo life-sustaining treatment (LST) from their children. We do not yet know how physicians and parents communicate about these decisions and to what extent parents share in the decision-making process.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Being a messenger of life-threatening conditions: experiences of pediatric oncologists.

              A nationwide population-based study with questionnaires involving 90 pediatric oncologists was performed in Sweden in 2006/2007. On the basis of this quantitative study, a qualitative study was performed. The aim of this qualitative study was to focus on the main concern of these physicians facing malignant disorders, psychosocial issues, and existential provocation. Furthermore, the strategies for handling these challenges were also studied.
                Bookmark

                Author and article information

                Journal
                J Med Ethics Hist Med
                J Med Ethics Hist Med
                JMEHM
                Journal of Medical Ethics and History of Medicine
                Tehran University of Medical Sciences (Tehran, Iran )
                2008-0387
                2017
                28 February 2017
                : 10
                : 2
                Affiliations
                [1 ]Professor, Division of Neonatology, Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
                [2 ]Assistant Professor, Department of Psychiatric Nursing, Iran University of Medical Sciences, Tehran, Iran.
                [3 ]Pediatrician, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
                Author notes
                [* ]Corresponding Author: Shiva Shayestefar. Address: Children’s Medical Center, 62 Gahrib Street, 1419733151 Tehran, Iran. Tel/Fax: +98 21 66920983 shivashayestefar@ 123456yahoo.com
                Article
                JMEHM-10-2
                5432945
                2f3ce53b-4b48-4321-931a-39243e450af8
                © 2017 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 March 2016
                : 1 January 2017
                Categories
                Original Article

                children,education,ethical conflict,pediatrics,resident
                children, education, ethical conflict, pediatrics, resident

                Comments

                Comment on this article