Thursday, 20 August 2009

The factors in change in paediatrics

Five general changes were noted as influencing practice in children:

1 Technical advances, making things possible which could not happen before – often bringing problems as well as advantages

2 The possibility of assigning prognosis to conditions found by screening raises the problem of information being available which it may not be appropriate or helpful to possess (e.g. a bad prognosis given ante-natally, which is not fulfilled post-natally may have a negative effect upon parental attitude towards the child). This is important because a high rate of false positive results is encountered in screening procedures. Unless action is to be taken on the results of the screening – e.g. termination of pregnancy – the screening may be counter-productive.

3 The new consumerism has an effect upon attitudes when things go wrong with the neonate. Society, as well as the individual, are seeking control of life’s events; technology seems to offer this, including control of the arrival of children on time and perfect. A baby may be viewed as a ‘consumer product’ or accession and biological variation may not be acceptable: a view which leads readily to the attitude – ‘if it is not right, dispose of it’.

From the Christian perspective, GOD has control – we do not. Our lives are in God’s hands at the beginning and the end. Human goal setting, ambition and consumerism must give way to our accountability and stewardship of life and relationships, for which we are answerable to God Himself. The question, ‘Am I my brother’s keeper?’, still evokes the answer ‘yes!’ from the highest authority in the matter.

4 Secular philosophy – discussed above – proposes the idea that babies are potential people, not real people. They are capable of life to the full, but if they are seen as not ‘capable’, they are likely to be considered disposable.

5 Health-care economics. Pressure on resources requires allocation of priorities. Babies may not be seen as a priority, especially if deformed or abnormal! Economics asks the question, ‘Is this expense good value for money?’.


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