Ethical Issues In Pediatric Hematology Oncology PDF Download

"Background: Each year, more than 200,000 children are diagnosed with cancer with an expected 5-year overall survival fluctuating between 60 and 80%: in Mexico, pediatric cancer remains the second cause of death in children. Although Mexico’s legislation establishes the lowest threshold for health care, standardization of clinical practices, and adequate ethically sound treatments are not completely defined. Since the United Nations Convention on the Rights of the Child in 1989, children’s specific rights rooted in the child’s best interests standard aim to set the appropriate environment for children to exercise their potential and actively participate in all matters affecting their wellbeing. Even though Mexico ratified and included the CRC in legislation, changes are far from what is expected in pediatric health care, a situation characterized by the scarce academic literature on the topic that reflects a lack of guidance for physicians and underrepresentation of children’s voices in discussions regarding their treatment. Objective: The overarching goal of this research project is to explore the concept of the child’s best interests standard described in the United Nations Convention on the Rights of the Child and included in Mexico’s legal framework, identify literature gaps, and present a tool for pediatricians working with children living with cancer to ensure rigorous and sound approaches to ethical concerns that arise in clinical care. Methods: Using Huxtable and Ives’s “mapping, framing, shaping framework for empirical bioethics research projects”, a process bridging this project’s different phases was followed to arrive at a normative recommendation. Initially, a mapping of the academic literature was conducted by performing a scoping review. Next, to frame the published knowledge in the area, a description of the findings related to the country was analyzed against the international literature in order to give shape to an ethics framework that will help pediatric oncologists in Mexico. To demonstrate the structured ethical analysis’s validity, the framework is applied to cases adapted from clinical practice. Results: The framework included in this research project developed a set of questions to be used by pediatric oncologists as a guide when performing the analysis of ethical concerns in clinical practice to help ensure the best available treatment and facilitate discussions between relevant stakeholders. Given the uniqueness of Mexico’s population, the framework was built to emphasize the importance of patient-centered care, how the child’s agency is considered, and how children’s voices are given precedence. Conclusion: This thesis explores the concept of the child’s best interests standard in Mexico from the perspective of the pediatric oncologist and its relationship with children’s rights, agency, and the decision-making process in clinical practice. In general, for children living with life-threatening diseases such as cancer, if they can acquire the ability to participate in the decision-making, results can better align with the child’s own best interests, instead of a surrogate’s preferences. Further research in the area is needed in Mexico to decrease the knowledge gap on how pediatric oncologists deal with the decision-making process and develop legal and ethical frameworks to adapt the child’s best interests standard to the country’s needs"--