Remarks of a paediatrician on informed consent in children

In medical practice, patients are frequently in a passive role with respect to consenting to medical measures. The basic threshold element of informed consent is medical competence to be controlled by individual self-criticism. The elements of information, such as disclosure and understanding, have to be adapted to the individual situation in order to achieve voluntariness and active autonomous authorization. In the paediatric age group, disclosure of information has to be guided by the age-dependent ability of understanding, leading to voluntariness and consent. Since force cannot be totally avoided in the management of children, parental information and consent should be as precise and conclusive as possible. The interaction between the paediatrician on the one hand, and the children and their parents on the other, is discussed.     

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??Primary immunodeficiencies??PIDs?? are a type of rare disease characterized by a defect in the components of host immune system??the majority of which are monogenic diseases. Molecular diagnosis is important to the precision management of PIDs. Traditional Sanger sequencing and next-generation sequencing??NGS?? are the major tools. Although the former one is the gold standard of checking single target gene and of confirming NGS results??NGS is also in increasing demand in clinical practice. Both of them have pros and cons??and are complementary to each other. A 4-step approach strategy comprising Sanger sequencing and NGS is proposed for the molecular diagnosis of PIDs by the author. Some suggestions for the NGS application are also provided.     

When parents refuse consent to treatment for children and young persons

One of the most difficult ethical dilemmas in paediatric practice is parental refusal to consent to life-saving treatment for their children. The ethical principles in such situations are complex. Although the 'best interests' of the child are of primary concern, these must be understood widely, as including all and not just medical interests. Though ultimately the courts must decide on a course of action where refusal is continued, we believe that in non-emergency cases consultation with a properly constituted multidisciplinary group will be of assistance. A national group of this kind has been recommended for New Zealand. This will ensure that all aspects of the cases are considered and can lessen the sense of 'parent versus medical profession' opposition. If this does not lead to a resolution, the opinion of the courts may be of assistance. Following a brief discussion of important ethical considerations, this article outlines a suggested constitution for an advisory committee and a set of guidelines for clinicians faced with parental refusal of treatment for their children.     

Pediatric Hematology and Oncology in Norway: A Brief Historical Review

Before World War II no real subspecialization occurred in Norwegian pediatrics. In the early 1950s hematology and oncology were adopted as fields of special interest by a Jew Norwegian pediatricians. Gradually an increasing expansion has taken place, particularly in pediatric oncology, in parallel with the great advances in cancer treatment.