Clinical problems with significant ethical implications
pose an ever increasing dilemma in everyday medical
practice in the 21st century and rarely present a simple
solution. This is particularly the case with ethical issues
involving children and those unable to take their own
decisions. Whilst the patients’ interests should come first
and all personal, cultural and religious bias eliminated,
the impact of costly treatment for the individual patient
on the available healthcare resources must also be taken
into account. Hence, it is essential to establish an ethically
acceptable code of practice which will allow doctors to
provide an objective approach to management that is
rational and consistent, both for the patient as well as
society at large regardless of creed or culture. An equally
important code of practice is required for medical research,
whether this involves clinical trials on children, laboratory
and animal studies. Although the same general principles
are applied to guide all medical ethical problems, these
may be adjusted to different research scenarios. Particularly
difficult issues relate to research involving subjects who
are unable to fully comprehend the ethical issues at stake,
especially the embryo, children and those with a disability,
as well as issues relating to the initiation of intensive care
or ‘extraordinary’ measures and, finally, issues relating to
the discontinuation of care and the dying process.peer-reviewe
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