Boles Richard E, Moore Jaime M, Glover Jacqueline J
University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, CO 80045, United States.
University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, CO 80045, United States.
Semin Pediatr Surg. 2020 Feb;29(1):150884. doi: 10.1016/j.sempedsurg.2020.150884. Epub 2020 Jan 18.
The decision to pursue metabolic and bariatric surgery (MBS) for pediatric patients has become increasingly accepted by patients and their families and by health care professionals. The advancement of pre- and post-operative MBS guidelines, based on accumulating evidence for safety, efficacy, and cost-effectiveness help to map the clinical pathway for MBS consideration. Ethical issues remain possible for each case, however, and consultation with ethical experts can provide clarity in the consideration of MBS. Specifically, ethical issues related to principles of autonomy, justice, beneficence, and non-maleficence may need to be resolved based on patient characteristics, including preadolescent patients and those who present with intellectual disabilities. Institutions that offer MBS for pediatric patients will benefit from collaborating with ethics consultants to develop a structured approach that helps ensure that ethical principles have been adequately addressed for patients presenting for MBS.
对于儿科患者而言，寻求代谢与减重手术（MBS）的决定已越来越为患者及其家属以及医疗保健专业人员所接受。基于越来越多关于安全性、有效性和成本效益的证据，术前和术后MBS指南的进步有助于规划MBS考量的临床路径。然而，每个病例仍可能存在伦理问题，与伦理专家进行咨询可以为MBS的考量提供清晰的思路。具体而言，可能需要根据患者特征，包括青春期前患者和有智力残疾的患者，来解决与自主、公正、行善和不伤害原则相关的伦理问题。为儿科患者提供MBS的机构将受益于与伦理顾问合作，制定一种结构化方法，以帮助确保为接受MBS的患者充分考虑伦理原则。
