Severe neurosurgical conditions in children

Vulnerable populations require a special application of bioethics to protect their rights, and babies and small children are the archetypal vulnerable population. They cannot speak for themselves and must rely on surrogate consent or substitute decision making usually from their parents. This can lead to conflicts between the patients' parents and members of the healthcare team. This chapter examines, through three examples encountered by neurosurgeons every day and everywhere, ethical challenges of treating babies and children with major neurosurgical conditions which have a high likelihood of altering quality and/or quantity of life. The examples are large thoracic myelomeningocele, intramedullary spinal cord tumor, and malignant tumor of the thalamus. The concepts of too much care, and inappropriate, disproportionate, and futile care are introduced. Other chapters which bear further on this subject include 5, 8, 9, and 12.

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