“I work with you, but I work for your child”: Clinicians’ Management of Ethical Dilemmas in Caring for Children with Food Allergies

Abstract: Food allergies are on the rise in the United States, and clinical approaches to managing patients’ food allergies have changed significantly in the past decade. Despite the extent to which food allergies affect children and families, there has been little bioethical engagement with the field of allergy. To fill this gap, we conducted a qualitative study to document how clinicians and clinical investigators define and understand the risks and benefits of current food allergy therapeutic options and to investigate the ethical issues that emerge in clinical practice. We interviewed 60 US-based clinicians about their approach to treating and managing children’s food allergies. From these interviews, one key ethical issue we identified was how allergists should include children in decision-making in an age-appropriate way about their own care. This issue is intimately tied to the larger question of the bodily autonomy of the child in health care. Although this is a complex ethical issue that can emerge in all pediatric care, we found that food allergy exacerbates the stakes for clinicians because the children may be quite vocally opposed to treatment and because clinicians voice concern that the treatments are largely addressing parental anxiety rather than ameliorating the child’s food allergy. In this paper, we discuss the ways in which doctors respond to this ethical dilemma and argue for the necessity of more advocacy by the doctors for the children in their care.

Maral Erol, Ph.D. – Research Specialist, Social Medicine, University of North Carolina at Chapel Hill