Ethical Issues in Paediatric Traumatic Brain Injury

Traumatic brain injury in children is challenging for many reasons not least of which is the prognostic uncertainty given the neuroplasticity which is inherent in a child’s central nervous system. This uncertainty leads to several ethical challenges which are specific to the paediatric population, and these evolve as the child develops both physically and intellectually. In the early years of a child’s development, parents are the sole decision-makers and will often be asked to make decisions which are in the child’s best interests. However, as a child develops through infancy and then into early adolescence, discussions regarding their medical care and the attendant ethical issues will need to reflect the child’s physical and intellectual maturation. Thereafter, as a child approaches adulthood and begins to develop opinions and self-interests, the “child” must have a more significant role regarding clinical decisions which must become more patient centred and reflect their developing values and sense of identity.