{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:41:42Z","timestamp":1759970502087,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: The field of paediatric bioethics addresses ethical issues in paediatric care, where parental authority often guides medical decisions, but children\u2019s preferences should also be considered. Promoting ethical awareness among minors can help them understand complex issues. This study aimed to analyse how sociodemographic, educational, and experiential factors shape adult perspectives on paediatric bioethical issues, particularly concerning pain and death. Methods: A questionnaire was developed to collect adult views of bioethical issues. The online questionnaire was disseminated via e-mail or WhatsApp. It started with an initial group of known individuals and then expanded hierarchically to include contacts of friends. Participants completed an online questionnaire, and data were analysed using SPSS version 22.0 for Windows. Clustering analysis identified two distinct groups. Results: This research focused on Italian adults (N = 889) aged 18 and over. Cluster 1, predominantly female (78.3%) and more highly educated (38.6% with postgraduate degrees), exhibited greater experience with paediatric bioethical issues (81.1%). This group favoured a collaborative approach, supporting shared training among adults (92.3%) and advocating for gradually addressing bioethical issues during childhood (84.3%). Cluster 2, with a higher proportion of males (31.5%) and parents (75.1%), showed lower educational levels (3.0% with middle school education) and less experience with bioethical concerns (93.5%). This group preferred a reactive, situation-specific approach to these issues. Conclusions: This study showed two distinct adult profiles regarding how they approach paediatric bioethics. The first group adopts a preventive and collaborative strategy, while the second group is more reactive and situation-driven. These findings can guide the development of tailored educational programmes to improve discussions about sensitive topics such as pain, incurability, and death in paediatric care.<\/jats:p>","DOI":"10.3390\/children12020120","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T04:54:31Z","timestamp":1737608071000},"page":"120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Distinct Profiles in Paediatric Bioethics\u2014An Analysis of Proactive and Reactive Approaches by Adults"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1639-8951","authenticated-orcid":false,"given":"Erika","family":"Rigotti","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Woman\u2019s & Child\u2019s University Hospital, I-37126 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8659-5505","authenticated-orcid":false,"given":"Marco","family":"Zaffanello","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Paediatrics, University of Verona, I-37129 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Patuzzo Manzati","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Paediatrics, University of Verona, I-37129 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5217-7957","authenticated-orcid":false,"given":"Giulia Adele","family":"Dinicola","sequence":"additional","affiliation":[{"name":"Cleveland Center for Bioethics, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Piacentini","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Paediatrics, University of Verona, I-37129 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Rodella","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Woman\u2019s & Child\u2019s University Hospital, I-37126 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Pozzuoli","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Woman\u2019s & Child\u2019s University Hospital, I-37126 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"De Manzoni","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Paediatrics, University of Verona, I-37129 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"ref_1","first-page":"88","article-title":"What makes a child a \u2019competent\u2019 child?","volume":"128","author":"Water","year":"2015","journal-title":"N. Z. Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Santoro, J.D., and Bennett, M. (2018). Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values. Behav. Sci., 8.","DOI":"10.3390\/bs8050042"},{"key":"ref_3","first-page":"11094","article-title":"Ethics of Pediatric and Young Adult Medical Decision-Making: Case-Based Discussions Exploring Consent, Capacity, and Surrogate Decision-Making","volume":"17","author":"Herbst","year":"2021","journal-title":"MedEdPORTAL"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1093\/medlaw\/fwad040","article-title":"How should we decide how to treat the child: Harm versus best interests in cases of disagreement","volume":"32","author":"Archard","year":"2024","journal-title":"Med. Law. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/02692163231214414","article-title":"Parents\u2019 experiences of being involved in medical decision-making for their child with a life-limiting condition: A systematic review with narrative synthesis","volume":"38","author":"Polakova","year":"2024","journal-title":"Palliat. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Grootens-Wiegers, P., Hein, I.M., van den Broek, J.M., and de Vries, M.C. (2017). Medical decision-making in children and adolescents: Developmental and neuroscientific aspects. BMC Pediatr., 17.","DOI":"10.1186\/s12887-017-0869-x"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1111\/bioe.13048","article-title":"Telling the truth to seriously ill children: Considering children\u2019s interests when parents veto telling the truth","volume":"36","author":"Gillam","year":"2022","journal-title":"Bioethics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1080\/07481180490432315","article-title":"A perspective on the current state of death education","volume":"28","author":"Wass","year":"2004","journal-title":"Death Stud."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.acap.2020.05.004","article-title":"Pediatrician Attitudes Toward and Experiences With Telehealth Use: Results from a National Survey","volume":"20","author":"Sisk","year":"2020","journal-title":"Acad. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Patuzzo Manzati, S., Galeone, A., Onorati, F., and Luciani, G.B. (2024). Donation After Circulatory Death following Withdrawal of Life-Sustaining Treatments. Are We Ready to Break the Dead Donor Rule?. J. Bioeth. Inq.","DOI":"10.1007\/s11673-024-10382-8"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/s11017-020-09535-8","article-title":"What we talk about when we talk about pediatric suffering","volume":"41","author":"Tate","year":"2020","journal-title":"Theor. Med. Bioeth."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Fraser, L.K., Bluebond-Langner, M., and Ling, J. (2020). Advances and Challenges in European Paediatric Palliative Care. Med Sci, 8.","DOI":"10.3390\/medsci8020020"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"van Teunenbroek, K.C., Kremer, L.C.M., Verhagen, A.A.E., Verheijden, J.M.A., Rippen, H., Borggreve, B.C.M., Michiels, E.M.C., and Mulder, R.L. (2023). Palliative care for children: Methodology for the development of a national clinical practice guideline. BMC Palliat. Care, 22.","DOI":"10.21203\/rs.3.rs-2984895\/v1"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Siebelink, M.J., Verhagen, A.A.E., Roodbol, P.F., Albers, M., and Van de Wiel, H.B.M. (2017). Education on organ donation and transplantation in primary school; teachers\u2019 support and the first results of a teaching module. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178128"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1001\/jama.283.7.909","article-title":"Conflicts regarding decisions to limit treatment: A differential diagnosis","volume":"283","author":"Goold","year":"2000","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s00431-021-04231-8","article-title":"Paediatric Residents and Fellows Ethics (PERFEct) survey: Perceptions of European trainees regarding ethical dilemmas","volume":"181","author":"Boer","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.4103\/jfmpc.jfmpc_103_21","article-title":"Knowledge and perception about bioethics: A comparative study of private and government medical college students of Karachi Pakistan","volume":"10","author":"Ashfaq","year":"2021","journal-title":"J. Family Med. Prim. Care"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Shirazi, B., Riaz, Q., Jafarey, A.M., Ahmed, R., and Shamim, M.S. (2024). The current status and challenges of bioethics education in undergraduate medical education in Karachi, Pakistan. BMC Med. Educ., 24.","DOI":"10.1186\/s12909-024-05599-5"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Thangavelu, P.D., Janakiraman, B., Pawar, R., Shingare, P.H., Bhosale, S., Souza, R.D., Duarte, I., and Nunes, R. (2024). Understanding, being, and doing of bioethics; a state-level cross-sectional study of knowledge, attitude, and practice among healthcare professionals. BMC Med. Ethics, 25.","DOI":"10.1186\/s12910-024-01028-w"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/pch\/9.2.85","article-title":"When parents and physicians disagree: What is the ethical pathway?","volume":"9","author":"Muirhead","year":"2004","journal-title":"Paediatr. Child. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s40889-022-00157-3","article-title":"Bioethics and adolescents: A comparative analysis of student views and knowledge regarding biomedical ethics","volume":"8","author":"Rizvi","year":"2023","journal-title":"Int. J. Ethics Educ."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4103\/IJPSYM.IJPSYM_110_18","article-title":"Does Sociodemographic Background Determine the Responses to Ethical Dilemma Vignettes among Patients?","volume":"41","author":"Gupta","year":"2019","journal-title":"Indian J. Psychol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"354","DOI":"10.4103\/jehp.jehp_1053_21","article-title":"The lived experience of parents from educating morality to their children Phenomenological study","volume":"11","author":"Valavi","year":"2022","journal-title":"J. Educ. Health Promot."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/2\/120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:34:07Z","timestamp":1759919647000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/2\/120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,23]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["children12020120"],"URL":"https:\/\/doi.org\/10.3390\/children12020120","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2025,1,23]]}}}