Innovation in Pediatric Neurosurgery: The Ethical Agenda

Abstract

Primum non nocere, first do no harm, is one of the profoundest ethical standards in medicine. Innovation has been an intrinsic characteristic of the development of medicine and has finally provided us with all the benefits of medical treatment for patients today. As a physician it is our moral duty to weigh the balance between potential harm and benefits before deciding to any treatment in an individual patient. An elementary aspect of an innovative treatment in children is that because of their young age and subsequently their expected remaining life, both the benefits and the potential harm may count for many years. Therefore, individual children could potentially benefit longest from innovative procedures if they are considered relatively safe. Innovation medicine should be incorporated in the pediatric age group for this elementary reason, but the avoidance of doing harm should be strictly safeguarded by the physician and the parents.

Children participating in innovative neurosurgical procedures represent a particularly vulnerable patient population, as they may commonly lack decisional capability, may show differential behavior toward adults, and may suffer from acute conditions to which no alternative treatment options are available. This vulnerability gives rise to various ethical challenges to neurosurgical innovation in children. Here we seek to address these challenges and to propose the learning healthcare system and its associated ethics framework as a potential solution.