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Ethical Issues in Pediatric and Congenital Cardiac Surgery

Constantine Mavroudis, MD, Michaela Asher, MD, MPhil, Constantine D. Mavroudis, MD, MSc, MTR, J Thomas Cook, PhD, Catherine L. Mavroudis, MD, MBA, Jeffrey P. Jacobs, MD, FACS, FACC, FCCP
Past Author: Allison Siegel, MSSA

Key Points

  • Core Bioethical Principles: The chapter emphasizes the four foundational principles guiding ethical behavior in surgery and medicine, including pediatric cardiac surgery:
    1. non-maleficence (do no harm),
    2. beneficence (do good),
    3. justice (fairness in resource distribution), and
    4. autonomy (respect for patient and family decision-making).
    These principles are especially complex in pediatrics, where parents or guardians make decisions on behalf of minors, often in high-stress situations with uncertain outcomes.
  • Informed Consent and Entrustment: The chapter explores two perspectives on informed consent:
    1. the legalist approach (focused on voluntariness, information provision, competence, and decision-making) and
    2. the entrustment approach (where families place trust in the surgeon’s expertise).
    Both are seen as complementary, with the process of building trust through clear, compassionate communication being as important as fulfilling legal requirements.
  • Transparency and Communication: Clear, quantitative information about risks, benefits, and outcomes is critical. The chapter highlights the importance of transparency in surgical outcomes and recommends that surgeons provide detailed, honest discussions about the natural history of the disease, treatment options, and their own experience, to foster trust and support informed decision-making.
  • Parental Perspective and Psychological Factors: Parents often seek more information than initially provided and may request second opinions—not as a challenge, but as a way to ensure the best for their child. The chapter notes that psychological factors such as risk aversion and focus on worst-case outcomes can influence decision-making, and surgeons must be sensitive to these dynamics.
  • Justice and Resource Allocation: The principle of justice is particularly challenging in the context of rare and expensive congenital heart diseases. The chapter discusses the ethical dilemma of allocating limited healthcare resources and the difficulty of balancing individual patient needs with broader societal considerations.

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Last updated: January 2, 2026