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Ethics of emerging technologies and their transition to accepted practice: intestinal transplant for short bowel syndrome

Abstract

Parental counseling becomes complex when considering the use of emerging technologies, especially if it is unclear whether the level of evidence is sufficient to transform the proposed therapy into accepted practice. This paper addresses ethical issues underlying medical decision-making and counseling in the setting of emerging treatments, when long-term outcomes are still in the process of being fully validated. We argue that the ethical transition of emerging technologies, ideally from ethically impermissible to permissible, to obligatory, depends primarily on two factors: outcome data (or prognosis) and treatment feasibility. To illustrate these points, we will use intestinal transplant for short bowel syndrome (SBS) as a specific example. After reviewing the data, this paper will identify the ethical justifications for both comfort care only and intestinal transplant in patients with ultra SBS, and argue that both are ethically permissible, but neither is obligatory. The approach outlined will not only be valuable as ultra SBS outcomes data continue to change, but will also be applicable to other novel therapies as they emerge in perinatal medicine.

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References

  1. American Academy of Pediatrics Committee on Fetus Newborn. Policy Statement. Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics 2010; 119 (2): 401–403 (2007, reaffirmed).

    Article  Google Scholar 

  2. Navarro F, Gleason WA, Rhoads JM, Quiros-Tejeira RE . Short bowel syndrome: epidemiology, pathophysiology, and adaptation. Neoreviews 2009; 10: e330–e338.

    Article  Google Scholar 

  3. Navarro F, Gleason WA, Rhoads JM, Quiros-Tejeira RE . Short bowel syndrome: complications, treatment, and remaining questions. Neoreviews 2009; 10: e339–e350.

    Article  Google Scholar 

  4. Olieman JF, Tibboel D, Penning C . Growth and nutritional aspects of infantile short bowel syndrome for the past 2 decades. J Pediatr Surg 2008; 43: 2061–2069.

    Article  Google Scholar 

  5. Andorsky DJ, Lund DP, Lillehei CW, Jaksic T, Dicanzio J, Richardson DS et al. Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes. J Pediatr 2001; 139: 27–33.

    Article  CAS  Google Scholar 

  6. Quiros-Teijeira RE, Ament ME, Reyen L, Herzog F, Merjanian M, Olivares-Serrano N et al. Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: a 25-year experience. J Pediatr 2004; 145: 157–163.

    Article  Google Scholar 

  7. Rossi L, Kadamba P, Hugosson C, De Vol EB, Habib Z, Al-Nassar S . Pediatric short bowel syndrome: adaptation after massive small bowel resection. J Pediatr Gastroenterol Nutr 2007; 45 (2): 213–221.

    Article  Google Scholar 

  8. Modi BP, Javid PJ, Jaksic T, Piper H, Langer M, Duggan C et al. First report of the international serial transverse enteroplasty data registry: indications, efficacy, and complications. J Am Coll Surg 2007; 204: 365–371.

    Article  Google Scholar 

  9. Goulet O, Joly F, Corriol O, Colomb-Jung V . Some new insights in intestinal failure-associated liver disease. Curr Opin Organ Transplant 2009; 14: 256–261.

    Article  Google Scholar 

  10. Vennarecci G, Kato T, Misiakos EP, Neto AB, Verzaro R, Pinna A et al. Intestinal transplantation for short gut syndrome attributable to necrotizing enterocolitis. Pediatrics 2000; 105 (2): e25–e29.

    Article  CAS  Google Scholar 

  11. Grant D, Abu-Elmags K, Reyes J, Tzakis A, Langnas A, Fishbein T et al. Intestine transplant registry: 2003 report of the intestine transplant registry: a new era has dawned. Ann Surg 2005; 241: 607–613.

    Article  Google Scholar 

  12. Selvaggi G, Tzakis A . Pediatric intestinal transplantation: literature review 2006–2007. Pediatr Transplant 2008; 12: 827–834.

    Article  Google Scholar 

  13. Goulet O, Sauvat F . Short bowel syndrome and intestinal transplantation in children. Curr Opin Clin Nutr Metab Care 2006; 3: 304–313.

    Article  Google Scholar 

  14. Lacaille F, Vass N, Sauvat F, Canioni D, Colomb V, Talbotec C et al. Long-term outcomes, growth and digestive function in children 2–18 years after intestinal transplantation. Gut 2008; 57: 455–461.

    Article  CAS  Google Scholar 

  15. Kocoshis SA . Short bowel and long life: no longer mutually exclusive. J Pediatr 2004; 145: 147–148.

    Article  Google Scholar 

  16. Lao OB, Healey PJ, Perkins JD, Horslen S, Reyes JD, Goldin AB . Outcomes in children after intestinal transplant. Pediatrics 2010; 125: e550–e558.

    Article  Google Scholar 

  17. Miller FG, Silverman HJ . The ethical relevance of the standard of care in the design of clinical trials. Am J Respir Crit Care Med 2004; 169: 562–564.

    Article  Google Scholar 

  18. Cooper TR, Caplan WD, Garcia-Prats JA, Brody BA . The interrelationship of ethical issues in the transition from old paradigms to new technologies. J Clin Ethics 1996; 7: 243–250.

    CAS  PubMed  Google Scholar 

  19. American Academy of Pediatrics Committee on Bioethics. Ethics and the care of critically ill infants and children. Pediatrics 1996; 98 (1): 149–152.

    Google Scholar 

  20. Tauesch HW, Ballard RA, Gleason CA . Avery's Diseases of the Newborn, 8th edn., vol. 18. Elsevier Inc.: Philadephia, PA, 2005.

    Google Scholar 

  21. Kon AA, Ackerson A, Lo B . How pediatricians counsel parents when no “Best-Choice” management exists: lessons to be learned from hypoplastic left heart syndrome. Arch Pediatr Adolesc Med 2004; 158: 436–441.

    Article  Google Scholar 

  22. Cooper TR, Garcia-Prats JA, Brody BA . Managing disagreements in the management of short bowel and hypoplastic left heart syndrome. Pediatrics 1999; 104: e48.

    Article  CAS  Google Scholar 

  23. Wernovsky G . The paradigm shift toward surgical intervention for neonates with hypoplastic left heart syndrome. Arch Pediatr Adolesc Med 2008; 162 (9): 849–855.

    Article  Google Scholar 

  24. Lantos JD, Frader J . Extracorporeal membrane oxygenation and the ethics of clinical research in pediatrics. N Engl J Med 1990; 323: 409–412.

    Article  CAS  Google Scholar 

  25. Chapman RL, Peterec SM, Bizzarro MJ, Mercurio MR . Patient selection for neonatal extracorporeal membrane oxygenation: beyond severity of illness. J Perinatol 2009; 29: 606–611.

    Article  CAS  Google Scholar 

  26. Beacuchamp TL, Childress JF . Principles of biomedical ethics,. 8th edn. Oxford University Press: New York, NY, USA, 2001, pp 225–282.

    Google Scholar 

  27. Mercurio MR . The ethics of newborn resuscitation. Semin Perinatol 2009; 33 (6): 253–263.

    Google Scholar 

  28. Cummings CL, Mercurio MR . Ethics for the pediatrician: autonomy, beneficence and rights. Pediatr Rev 2010; 31: 252–255.

    Article  Google Scholar 

  29. American Academy of Pediatrics Committee on Bioethics. Guidelines on religious objection to medical care. Pediatrics 1997; 99 (2): 279–281.

    Article  Google Scholar 

  30. Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972).

  31. Scientific Registry of Transplant Recipients: U.S. Hospitals with Intestine Transplant Centers. http://www.ustransplant.org/csr/current/Centers/TransplantCenters.aspx?organ=Intestine (accessed 23 September 2010).

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Correspondence to C L Cummings.

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Cummings, C., Mercurio, M. Ethics of emerging technologies and their transition to accepted practice: intestinal transplant for short bowel syndrome. J Perinatol 32, 752–756 (2012). https://doi.org/10.1038/jp.2012.69

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  • DOI: https://doi.org/10.1038/jp.2012.69

Keywords

  • medical ethics
  • medical decision-making
  • newborn
  • new technology
  • short bowel syndrome
  • intestinal transplant

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