Exploring the Ethical Landscape of Pediatric Neuroendovascular Treatments

Abstract

The treatment of neurovascular disease in children continues to push clinical and innovative boundaries, carrying with them uniquely high stakes. Hemorrhage from, or occlusion of, a major cerebral blood vessel may result in devastating neurological injury or death. In children and young people, the stakes around a decision to offer or withhold treatment are even greater. The implications of long-term neurodisability in a young child who may live for many decades with the aftermath of brain injury must also be considered. Contemporary clinical management of children with neurovascular disorders involves a wide range of unique ethical challenges. Evolving technologies for neurovascular diagnosis and treatment will be accompanied by new and unprecedented ethical issues. In this article, we explore and discuss the key ethical principles, frameworks, and broader challenges pertinent to pediatric neurovascular disease and its management; challenges to informed consent, best interests, balancing beneficence, burden and nonmaleficence, ethics related to genotype-directed pharmacotherapy, and global health considerations are addressed. Precision child health will see an increase in volume of patients, particularly for tertiary/quaternary neurovascular units, where ethical considerations will be pushed into a new frontier, requiring a high level of ethical literacy from all team members.

Keywords: cerebrovascular; child health; ethics; informed consent; intracranial hemorrhage.