Ethics of developing autonomy in child healthcare: International and European perspectives

Respect for the children’s developing autonomy in paediatric healthcare, especially with regards to national vaccination programs, may be expressed differently across Europe. Despite the differences, common ethical patterns and good practices may be identified and transferred across the region. Although the paediatrician’s role may be decisive in addressing ethical dilemmas, it is unclear if ethics is adequately included in their resident curricula. This dissertation studies paediatric resident curricula, identifies recurrent teaching patterns and problems and suggests solutions. It addresses ethical dilemmas regarding the provision of prophylactic vaccinations to tackle infectious diseases in childhood, focusing on the cases that the decision of the caregivers and the children do not align and introduces a model to discuss such cases. This model is further validated using a Rights-based approach to discuss ethics, as proposed by the American Society of Pediatrics. Finally, differences regarding expressions or respect for children’s developing autonomy throughout Europe are being explored and studied, also in association with national vaccine coverage rates across the European Union. Thus, this thesis identifies the most suitable ethical approaches to be transferred and implemented across Europe.