Scholarlink

Background <p>Individual treatment attempts (ITAs) in children represent paradigmatic decision-making situations in which medical indication, prognostic uncertainty, parental representation, and child vulnerability must be normatively mediated. They arise not only in end-of-life situations but also in contexts of limited evidence, for example when therapeutic approaches are transferred from adult medicine to paediatrics. How moral action-guiding relevance is practically constituted in such constellations has not yet been systematically analysed.</p> Objective <p>The aim of this study is to reconstruct clinical–ethical decision-making processes in ITAs and to identify the normative structural categories guiding deliberation.</p> Methods <p>Based on a&#xa0;reconstructive empirical–ethical approach, two contrasting anonymised decision contexts from paediatric oncology in palliative care settings were analysed. The data comprised clinical case documentation, interdisciplinary case discussions and clinical ethics consultation documentation. The objective was not to evaluate individual decisions, but to reconstruct implicit normative attributions and structural categories of clinical practice.</p> Results <p>The analysis identifies three central structural categories: (1)&#xa0;the relational attribution of children’s participatory capacity, (2)&#xa0;the normative interpretation of uncertainty within proportionality assessments, and (3)&#xa0;the institutional framing of responsibility. Identical ethical principles lead to divergent decisions depending on the context.</p> Conclusion <p>ITAs in children demonstrate that clinical decision-making under conditions of uncertainty is not adequately described as a&#xa0;schematic application of ethical principles, but rather as a&#xa0;context-sensitive process in which principles are interpreted, weighted and mediated through context-dependent attributions, relational autonomy and institutional structuring. The findings contribute to the conceptual refinement of relational autonomy and proportionality in paediatric medical ethics.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Individuelle Heilversuche bei Kindern: Eine rekonstruktive Analyse klinisch-ethischer Entscheidungsstrukturen unter Bedingungen von Unsicherheit

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月1日

查看全文
  • Francesca Alt

摘要

Background

Individual treatment attempts (ITAs) in children represent paradigmatic decision-making situations in which medical indication, prognostic uncertainty, parental representation, and child vulnerability must be normatively mediated. They arise not only in end-of-life situations but also in contexts of limited evidence, for example when therapeutic approaches are transferred from adult medicine to paediatrics. How moral action-guiding relevance is practically constituted in such constellations has not yet been systematically analysed.

Objective

The aim of this study is to reconstruct clinical–ethical decision-making processes in ITAs and to identify the normative structural categories guiding deliberation.

Methods

Based on a reconstructive empirical–ethical approach, two contrasting anonymised decision contexts from paediatric oncology in palliative care settings were analysed. The data comprised clinical case documentation, interdisciplinary case discussions and clinical ethics consultation documentation. The objective was not to evaluate individual decisions, but to reconstruct implicit normative attributions and structural categories of clinical practice.

Results

The analysis identifies three central structural categories: (1) the relational attribution of children’s participatory capacity, (2) the normative interpretation of uncertainty within proportionality assessments, and (3) the institutional framing of responsibility. Identical ethical principles lead to divergent decisions depending on the context.

Conclusion

ITAs in children demonstrate that clinical decision-making under conditions of uncertainty is not adequately described as a schematic application of ethical principles, but rather as a context-sensitive process in which principles are interpreted, weighted and mediated through context-dependent attributions, relational autonomy and institutional structuring. The findings contribute to the conceptual refinement of relational autonomy and proportionality in paediatric medical ethics.