Introduction: the importance of outcome

Like all doctors, paediatricians are constantly faced with clinical decisions that are informed by evidence of fact but must be made in an ethical context in which decisions may be deemed morally right or wrong. This article is one of a series of ‘bulletins’ setting out some general philosophical principles that are important in medical ethics and, where possible, showing how they need to be specified to paediatrics.

Evidence and ethics are clearly connected. One way to know whether or not a decision was right is to look at what happens as a result, and most moral theories acknowledge that outcome is, at the least, highly relevant to whether or not a decision is right. Judged on its outcome, however, the same decision can be deemed right or wrong simply by changing how it is evaluated. Legislation enforcing mass vaccination might be right if ‘rightness’ is evaluated as the number of lives saved, but wrong if ‘rightness’ represents the amount of individual liberty preserved. It is important to ensure that the outcome we use to evaluate moral action at a given point in time is appropriate.

That presents paediatrics with a challenge. Choosing an appropriate outcome depends on first deciding what the proposed action is intended to achieve. Evaluating interventions solely on the basis of their capacity to cure, for example, gives no moral value to symptom control; children experience many conditions which cannot currently be cured, but whose symptoms can be prevented or treated. For paediatricians to be confident that an outcome correctly identifies a decision as morally right, it must represent something that is relevant to how individual children are enabled …