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Commentary on “Pulmonary tuberculosis and extreme prematurity”
  1. V Larcher
  1. Royal London Hospital, Whitechapel, London E1 1BB, UK;

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    The case history given by Katumba-Lunyenya et al presents several ethical dilemmas.

    The core moral principle of medicine is that professionals should act in the best interests of their patients This entails two sometimes conflicting duties:1

    1. To protect the life and health of patients by providing treatments that maximise benefits and minimise harms

    2. To respect a competent patient’s right to decide for themselves what should be done to them (respect for autonomy)

    They should fulfil these duties justly and fairly and to an appropriate standard. It follows that professionals have a duty to obtain consent for treatment, respect confidentiality of personal information given to them by patients, and to consider the consequences of their actions on others under their care.2

    Adults are free to determine their best interests irrespective of professional opinion, but children who lack the capacity to decide for themselves are not. Parents, in partnership with professionals, have an ethical duty and legal authority to make decisions on behalf of such children as the infant described, provided that they act in the child’s best interests. The case described clearly raises a number of ethical issues.


    All medical treatment requires valid consent. To be ethically and legally valid, consent must be sufficiently informed and given freely by a person who is competent to do so.3 The information required is that which a reasonable patient, or in this case parent, might need to make a decision about the treatment in question. In practice, there may be difficulties in presenting complex information—for example, the need for antiretroviral …

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