Ethics In Pediatric Pelvic Health: Navigating Ethical Dilemmas In Clinical Practice

By Mora Pluchino DPT

One of the most underrated continuing education topics in healthcare is ethics. Therapists often view it as something you complete just to check a box or fulfill a requirement. But after 17 years in practice, I can tell you this: the questions my colleagues wrestle with most are deeply rooted in ethical decision-making.

This is especially true for those working in niche populations, particularly pelvic health and pediatrics.

Pelvic health itself is already a specialty area. Pediatric pelvic health? That’s a niche within a niche, and it comes with a plethora of ethical considerations and concerns. You can have all the clinical knowledge and hands-on skills in the world, but still be haunted by ethical decision-making that comes when working with children and their caregivers.

Let’s walk through a scenario:

*Lu is a 15-year-old presenting to pelvic floor therapy for an appointment scheduled by their mother. They arrive with their parents, and mom reports the primary concern as a recent urinary tract infection (UTI).

As you take the history, both Lu and their mom explain that Lu had a UTI and received antibiotics at urgent care. By day three, Lu was symptom-free. Their current bowel and bladder habits appear normal based on responses to the PFDI-20.

As you continue reviewing the PFDI-20 (which Lu completed independently and handed directly to you), you notice an important note. Next to the question, “Are you sexually active?” Lu has written:

“Yes, I am here because that hurts, but I don’t want my mom to know.”

Mom shares that Lu asked to come in after seeing a TikTok suggesting UTIs can be related to pelvic floor issues. Lu has also seen a gynecologist for painful periods and has been on hormonal birth control for two years.

Both Lu and Mom consent to an external and internal pelvic floor muscle examination. Mom offers Lu privacy, and Lu states they feel comfortable with you and would prefer privacy during the external and internal exam.

How do you feel reading this case?

• Would you feel confident navigating this situation?
• Would you want to call a colleague or mentor?
• How would you proceed with Lu’s care?
• Would you tell Lu you can’t treat them for this issue?
• Would you disclose Lu’s true concerns to their parent?

Do you now have more questions than answers? Welcome to practicing through an ethical lens!

This scenario is exactly the kind of situation where clinical skill alone isn’t enough. Using the RIPS Model (Realm-Individual Process-Situation), we can begin to unpack what’s happening here. This model provides an ethical framework to break down cases that feel tricky.

This is a situational ethical issue with strong individual components. The primary tension lies between respecting Lu’s autonomy & confidentiality and the parent’s legal role in consent & involvement.

You’re faced with balancing multiple competing ethical principles at once:

• Beneficence → treating Lu’s pain
• Autonomy → honoring Lu’s request for privacy
• Veracity → being truthful with the parent

Lu demonstrates maturity and insight by independently disclosing sensitive information and requesting privacy. This supports consideration of the minor’s wishes, particularly in the context of reproductive and sexual health.

However, you must still operate within legal boundaries, ensuring that care is delivered appropriately while avoiding harm. This includes the potential emotional harm caused in the therapeutic relationship with the caregiver and child if trust is broken.

From a decision-making standpoint, this is not a clear-cut ethical violation. This is primarily a right vs. right dilemma.

Using the RIPS framework, your role as the therapist involves:

• Moral sensitivity → recognizing the ethical tension
• Moral judgment → weighing autonomy vs. parental involvement
• Moral courage → acting in a way that protects Lu’s well-being while still appropriately involving the parent in the patient care and decision making

The most ethical path forward includes:

1. Creating a private space to assess Lu’s safety and preferences
2. Clearly explaining the limits of confidentiality in pediatric care
3. Collaboratively determining what information can be shared with the parent to allow care to proceed

This approach allows you to maintain trust with Lu while supporting their engagement in care. It also aligns with your professional responsibilities, while still ensuring appropriate consent and safeguarding obligations are met.

These are the moments that define pediatric pelvic health practice. Not the textbook cases. But the messy, nuanced interactions where ethics, communication, and clinical care all intersect.

The goals of Ethical Decision-Making in Pediatric Pelvic Health are to help you:

• Identify how ethical situations come up when treating this population
• Create an action plan based on assessment of different angles
• Develop increased confidence using practical strategies you can implement immediately

So whether the situation feels big or small, you can move forward knowing you’re making thoughtful, ethical, and patient-centered decisions.

If you’ve ever walked away from a session wondering, “Did I handle that the best way?”, then this course is for you.

*patient name changed for privacy