Ethics for the Pediatrician: Autonomy, Beneficence, and Rights

Christy L. Cummings, MD* 2. Mark R. Mercurio, MD, MA† 1. *Department of Pediatrics, Division of Neonatology, Yale University School of Medicine, New Haven, Conn. 2. †Associate Professor, Department of Pediatrics, Yale University School of Medicine; Director, Yale Pediatric Ethics Program, New Haven, Conn. Editor's Note: In response to the addition of a new section entitled Ethics for Primary Pediatricians to the American Board of Pediatrics' core content , Pediatrics in Review offers a series of articles on many aspects of ethical decision-making. The writing and reviewing of articles are contributed primarily by members of the American Academy of Pediatrics Section on Bioethics. Unique to pediatrics is the physician-patient-parent relationship. Medical decisions are made best with the rights and obligations of each of these individuals kept in mind as well as an understanding of widely accepted principles of medical ethics. This article presents a brief overview of the ethical principles of autonomy and beneficence; the patient's best interest standard; and the rights of parents, children, and adolescents in medical decision-making. Each is discussed in light of relevant policies and guidelines of the American Academy of Pediatrics (AAP). It should be noted that the principle-based analysis described herein is one reasonable approach to ethical decision-making in the practice of pediatrics, but there are others. The reader also is encouraged to consider other approaches, such as care-based ethics or feminist ethics, to gain a fuller appreciation of the issues. (1)(2)(3) The word autonomy derives from the Greek words auto , meaning self, and nomos , meaning governance or rule. The principle of autonomy refers to the individual's right (in this case, the patient's right) to make decisions and act on them freely and without interference. (1) One person's right often implies another's obligation, and in the case of autonomy, if one person has a right to control what is done to …