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80 Ethics of Paediatric Surgery in Africa

to the opinion and wishes of children who are not able to give full con- Table 13.1: Evidence-based research.
sent and should strive to obtain their assent. The consent/assent process Title Informed consent/assent in children. Statement of the
must promote and protect the dignity, privacy, and confidentiality of the Ethics Working Group of the Confederation of European
child and his or her family. Specialists in Paediatrics (CESP)
Conclusion Authors De Lourdes Levy M, Larcher V, Kurz R
This chapter has addressed some of the ethical issues that the paediatric Institution Ethics Working Group of the CESP, Department of
Paediatrics, University Hospital Graz, Graz, Austria;
surgeon may encounter. The relationship is three-pronged: the child- University Clinic of Pediatrics, Hospital de Santa Maria,
patient, the decision maker (parent/caregiver), and the surgical team. It Lisbon, Portugal; Queen Mary’s School of Medicine and
Dentistry, London, UK
is important that the surgeon be aware of the ethical issues and moral
dilemmas influencing this relationship, and that the child’s best inter- Reference Eur J Pediatr 2003; 162(9):629–633
ests remain paramount. In many African countries, resource constraints Problem A report by a working group of experts assembled from
also play an important role; here the surgeon must weigh the risks and several European countries providing paediatric health
care practitioners with guidelines on informed consent and
benefits of surgery to the patient and advocate for the patient where assent.
appropriate. There is also an obligation for the experienced surgeon to
Intervention Expert opinion.
convey knowledge, skills, and values to other staff and to the public.
Outcome/ Consent or assent is required for all aspects of medical
Evidence-Based Research effect care, for preventive, diagnostic, or therapeutic measures
Table 13.1 presents an expert opinion on European guidelines regarding and research. The consent/assent process must promote
and protect the dignity, privacy, and confidentiality of the
informed child assent. child and his or her family.
Historical This report extends and clarifies similar guidelines issued
significance/ by the American Academy of Paediatrics, Committee on
28
comments Bioethics.

Key Summary Points

1. Surgeons should be aware of the specific cultural, 4. Informed parental consent should always be obtained before
psychological, and ethical milieu to which the child and family surgical procedures to whatever extent possible even in
belongs. emergencies.
2. Practice should be guided by the ethical principles of patient 5. Informed child assent should be sought, as appropriate to the
autonomy, respect for persons, nonmalfaisance, beneficence, child’s development, age, and understanding.
and justice.
3. African ethics is based on communal, rather than individual,
values.

References

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