Etiology and Manifestations of Iatrogenesis in Pediatrics

Stowe Locke Teti, Kathleen Ennis-Durstine, Tomas Jose Silber

There is general agreement in the literature of what ought to occur following iatrogenic harm. Senior members of the team should disclose what occurred and how the problem will be remedied. Those involved should express heartfelt regrets and apologize sincerely. But in the pediatric setting, parents, as surrogates, can sometimes place clinicians on the horns of a dilemma: respect parental autonomy, which may involve continuing nonadvised therapy, or uphold the patient's best interests, which may indicate another course of care. In other cases, clinicians themselves may initiate or continue care without real benefit. The young patients who may be harmed as a result often cannot understand an explanation, an apology, or, when warranted, receive reparation; what duties are owed them? In this paper, we first discuss iatrogenesis writ large and then propose the formulation of this concept in this latter context, where harm occurs as a result of counterpoise between two or more ethical obligations, which we term counterpoise iatrogenesis. We then articulate its etiology and manifestation through two true cases. We conclude with a re-examination of the meaning and function of autonomy in pediatrics and the designation of secondary victims.