How Shall We Treat the Children in the 21st Century?

My father was graduated from the University of Colorado Medical School in 1910. He was 24 years old, the youngest in his class of 50 (there were no female graduates). In 1960, the same year I was graduated from UCLA Medical School, he attended his 50th-year class reunion in Denver. Adding his 56 years in medical school and practice to my 44 years of training and practice, I can present a personal history of medicine in the 20th century. My father's internship and residency was simple. He apprenticed himself to a senior physician for 3 years and, following him from patient to patient, delivered babies, performed surgery, and counseled the dying. There were few instruments. Clysis was the standard treatment for ascites-diabetes was fatal. Intravenous needles were not yet in use. Medications were few-morphine, aspirin, phenobarbital. Physical diagnosis was an art-listening to the chest wall to diagnose a tubercular lung or examining earlobes, conjunctiva, and nail beds for anemia provided the answers. Surgical gloves were just beginning to be used for operations and obstetrical deliveries. There were no rules to govern many decisions, such as whether to inform patients of an anencephalic newborn. Such ethical decisions had to be made on the spot, without consultation.