Ethical Considerations of Unsedated Esophagogastroduodenoscopy in Pediatric Patients

A 10 year-old child requires an esophagogastroduodenoscopy (EGD). One of the child’s parents is requesting an unsedated esophagogastroduodenoscopy, citing their experiences in a different country and concerns about anesthetic medications. The child is assenting to the procedure. The patient previously had multiple sedated EGDs without complications. Concerns are raised by the anesthesia, GI, and operating room teams about the ethics and child safety of performing an unsedated EGD, given this is not the typical standard of care at the performing hospital. In this paper we analyze prior literature and ethical principles, and explore whether unsedated EGD with appropriate monitoring is an ethically acceptable alternative to sedated EGD in this instance.