As many as 1 in 10 patients is harmed while receiving hospital care in wealthy countries. The risk of health care–associated infection in some developing countries is as much as 20 times higher. In response, in many global regions, increased attention has turned to the implementation of a broad program of safety research, encompassing a variety of methods. Although important international ethical guidelines for research exist, literature has been emerging in the last 20 years that begins to apply such guidelines to patient safety research specifically. This paper provides a review of the literature related to ethics, oversight, and patient safety research; identifies issues highlighted in articles as being of ethical relevance; describes areas of consensus regarding how to respond to these ethical issues; and highlights areas where additional ethical analysis and discussion are needed to provide guidance to those in the field.

As many as 1 in 10 patients is harmed while receiving hospital care in wealthy countries. The risk of health care-associated infection in some developing countries is as much as 20 times higher. In response, in many global regions, increased attention has turned to the implementation of a broad program of safety research, encompassing a variety of methods. Although important international ethical guidelines for research exist, literature has been emerging in the last 20 years that begins to apply such guidelines to patient safety research specifically. This paper provides a review of the literature related to ethics, oversight, and patient safety research; identifies issues highlighted in articles as being of ethical relevance; describes areas of consensus regarding how to respond to these ethical issues; and highlights areas where additional ethical analysis and discussion are needed to provide guidance to those in the field.

Since the advent of IVF, various arrangements for child bearing and rearing have developed. With the confluence of advanced medical technology, reproductive choice, and globalization, a market in international surrogacy has flourished. However, myriad health, social, and ethical concerns abound regarding the well-being of gestational carriers and children, the infringement of autonomy and free choice, and threats to human dignity. The present paper examines the scope, health risks, and ethical concerns of cross-border surrogacy, arguing that the risks may not exceed the benefits.

Atrial fibrillation (AF) is rare in the pediatric population; however, there is increasing recognition that AF can be inherited. Long QT syndrome (LQTS), likewise, can be both acquired and inherited with mutations leading to abnormalities in cardiac ion channel function. Mutations in KCNQ1 are the most common cause of LQTS. Although rare, mutations in KCNQ1 also can cause familial AF. This report describes a child with a KCNQ1 missense mutation who uniquely expresses concomitant AF and LQTS. Due to the potential for increased morbidity and mortality, young patients who present with AF and a family history suggestive of inherited arrhythmias should trigger further investigation for LQTS and subsequent familial genetic counseling.

A 3-month-old Albanian female infant presented to the emergency department with her biologic mother and father after allegedly falling from her swing onto her face. Through an interpreter, the biologic mother reported swaddling the baby and putting her in an electric swing. The swing was placed on a wooden stool. A few minutes after starting the mechanical swing, mother stated that it toppled off the wooden stool. The infant subsequently landed face down onto a carpet runner overlying the ceramic tile floor. The mother reported that the baby cried immediately and had blood coming from her mouth. She did not report loss of consciousness, apnea, or vomiting. Physical examination showed a sleeping 3-month-old girl resting comfortably. A blood clot was noted along a 1-inch skin flap that extended from the front to the middle of the upper right gum line. Conjunctiva were clear. Upper, lower, and sublingual frenula were intact. Her skin was significant for a rather faint petechial injury along the left upper lip vermilion border. The remainder of the exam was normal. The infant was born at term via spontaneous vaginal delivery without complications. Family history was negative for connective tissue disorders, frequent bone fractures, or other inherited bone diseases. Computed tomography (CT) revealed a minimally displaced comminuted fracture of the right mandibular ramus extending to the base of the condylar process; the study was negative for intracranial hemorrhage or other injury (Figure 1). A skeletal survey was performed and showed a questionable cortical irregularity of the right distal ulna that was seen on only one view. An ophthalmologist observed no retinal hemorrhages. Blood work, including serum electrolytes, liver function tests, and a complete blood count were all within normal limits. The pediatric plastic surgery service expressed concern that a mandibular fracture is exceedingly rare in infants. The pediatric radiologist queried whether this traumatic injury was induced nonaccidentally. Thus, given the rare nature of these fractures in infants and implausibility of the reported mechanism of injury, the primary team consulted the hospital child protection program for concern of nonaccidental trauma. Child Protective Services (CPS) was contacted and, in conjunction with law enforcement, conducted a scene investigation while the infant remained in the hospital. It was discovered that the electric swing had been placed atop four small wooden circular barstools that were 18 inches high; the total height of the stools and swing came to 40 inches (Figure 2). The swing initially appeared stable when placed on the stools; however, once turned on, it became unsteady. Further inspection revealed that the plastic grippers on the base of the swing were worn off in 3 locations. The child protection program concluded that the unilateral mandibular fracture was consistent with the accidental mechanism initially reported, and CPS formally cleared the infant for discharge to home in the care of her parents. The child protection program recommended a 2-week follow-up appointment with a repeat skeletal survey to reevaluate the distal ulna lesion, which proved to be normal.