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J Pediatr Surg. 2008 Jun;43(6):986-93. doi: 10.1016/j.jpedsurg.2008.02.016.

Experience of moral distress among pediatric surgery trainees.

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Division of General Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada M5G 1X8.



The aim of this study was to identify and qualify the ethical dilemmas faced by pediatric surgery trainees.


An online survey was sent to pediatric surgery trainees graduating between 2005 and 2008. Consent was obtained, and study investigators were blinded to the identity of the respondents during data analysis.


Of the 40 respondents, only 59% felt they had received adequate training in bioethics to handle ethical issues pertaining to the care of critically ill children. Although 83% of respondents routinely participated in palliative care discussions, 30% of respondents desired to have more opportunities to discuss end-of-life issues with their staff. Moral conflicts were resolved through direct discussions with the medical staff, family, or friends. Despite the presence and awareness of institutional policies on ethical behavior, 58% of respondents did not believe that ethical conflicts were resolved as a result of these policies, whereas 31% of respondents felt that reporting of unethical conduct would result in personal reprisals.


Pediatric surgery trainees face ethical and moral conflicts, but some are fearful of reprisals if these concerns are reported. A neutral forum to raise such issues may facilitate open discussions and eventual resolution of these conflicts.

[Indexed for MEDLINE]

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