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Ethical Need in the Pediatric Setting


According to Johnson et al. (2015), ethical dilemmas in nursing relate to particular challenging incidences since the dilemma encompasses conflict experienced between professional accountability and personal preservation. On the other hand, Santoro and Bennett (2018) indicated that in a pediatric nursing setting, ethical dilemmas present exceptional challenges since the dilemmas include minors and third parties, mainly parents and guardians to the kid. Ethical dilemma in pediatrics results from the fact that minors are not in a position to make their treatment decision, a role that is legally vested to the parent or guardian. In the selected article, the medical issue of separating conjoined twins has been established to have substantial ethical consequences. This paper explores the ethical dilemma on the issue of conjoined twins as presented in the article. It provides a background to the problem, the solution implemented, and my standpoint on the issue.

Analysis of the Ethical Dilemma 

The Ethical problem from the article come into the limelight in 2017 in Massachusetts General Hospital, which entailed the separation of conjoined twins. According to the article by Malone (2017), the conjoined twins were 22 months and they were girls from Africa and shared several essential organs among them bladder and liver. The twins were conjoined at the abdomen and pelvis. Following some surgical analysis in a Massachusetts hospital, it was found that the separation process would save only one life. Despite this, failure to have undertaken the surgical separation of the twins would have resulted in the death of the two. In such a situation, the surgical team engaged and made the decision on which among the twin was to be saved.

Ultimately, after the surgical operation was carried out as expected, one of the twins died (Malone, 2017). However, one survived and according to the report, she is fine. In this dilemma, the team involved various individuals inclusive of the twins’ parents, a multidisciplinary team comprising of health professionals who took part in the surgical separation process, and a Massachusetts hospital ethical team. In this case, the parents can be considered as the primary caregivers and custodians of the twins. On the other hand, the multidisciplinary team of professionals comprised specialist surgeons, nurses, and anesthetists and had a role to provide appropriate intervention to the twins either before, during, or after the operation. Besides, the ethical team from the hospital had the role of assisting the healthcare experts and parents to make an informed decision. This was enhanced through the provision of relevant information regarding the possible risks and benefits of the failure of undertaking or not undertaking the separation surgical operation (Malone, 2017).

In this scenario, several ethical principles have been demonstrated. Some of the ethical principles in the dilemma are beneficence, nonmaleficence, and autonomy. Through the autonomy principle, individual patients are granted the right of taking part and in making decisions concerning their medical process (Santoro & Bennett, 2018). In this case, the conjoined twins were minors and they were not in a position of providing truly informed consent thus the parents acted on their behalf. The Nonmaleficence principle requires healthcare experts to not harm (Johnson et al., 2015). In the present ethical dilemma, the surgery entailed harm to one of the conjoined twins but would save one of them. In such a case, the decision to harm one of them at the expense of the other was quite challenging. Finally, the beneficence principle is established in the promotion of goodness in others by avoiding causing harm (Santoro & Bennett, 2018). In this case, engaging in the separation surgery aimed to promote the wellbeing or goodness of the twins since failure to have undertaken the surgery would lead to the death of both.

According to Malone (2017), the solution on care indicated separating the twins via surgical operation was the only option that could have promoted better health outcomes for one of the twins. If they were not separated, it was indicated that they would have both died. Despite this, each of the twins had an equal right to life. In addition, the parents had to act on behalf of the twins and make the decisions. Nonetheless, the surgical team had the role of considering the twins’ and the parent’s rights and coming up with decisions that would lead to the best possible result (Malone, 2017). Thus, the Massachusetts hospital pediatric ethics committee had to assume the role and informed the parents on some of the potential risks and benefits of undertaking the surgical separations of the conjoined twins. In the end, the professionals executed the separation surgery where the weaker and smaller twin died and the other one survived and fully recovered from the operation. In resolving the dilemma, my thinking relates to the idea that healthcare experts applied the “standard of best interest” which was based upon their actions and what they perceived as the best benefit to the conjoined twins.


In resolving the dilemma, the core resource used was the pediatric ethics committee which assisted the healthcare profession and parents of the twins to come up with informed decisions for the pediatrics dilemma. Despite this, it is worth noting that the pediatric ethics committee has a role of providing all relevant information to all the parties detailing possible benefits and adverse outcomes that would follow after engaging or not engaging in a particular action.


Johnson, L. M., Church, C. L., Metzger, M., & Baker, J. N. (2015). Ethics consultation in pediatrics: long-term experience from a pediatric oncology center. The American Journal of Bioethics15(5), 3-17.

Malone, S. (2017 June). Conjoined twins posed ethical dilemma for Massachusetts hospital.

Santoro, J. D., & Bennett, M. (2018). Ethics of end-of-life decisions in pediatrics: a narrative review of the roles of caregivers, shared decision-making, and patient centered values. Behavioral Sciences8(5), 42.


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