Ethical principles should be always present in communication:
Children require open and flexible communication. When any two parties communicate with each other, there is an implicit promise that both will speak truthfully and that they will not deceive each other.
Even though children may not legally be allowed to enter into formal contracts the implied promise remains important.
When parents refuse to reveal the diagnosis to their child, practitioners may assume the role of trustworthy educator(3).
This principle is based on the principle of respect for autonomy.
In pediatric palliative care the expectation of privacy in the patient provider relationship may be tested in dealing with individual patient wishes, extended family or friends, schools and community.
Medical practice requires the patient to disclose private and sensitive information.
When confidentiality is breached, a failure of fidelity corrupts the patient provider relationship (most evident in dealing with adolescents)
The obligations of fidelity are best understood as norms that specify the moral principles of autonomy, justice and utility.
The patient provider relationship is founded on trust and confidence, the breach of fidelity is abandonment of that relationship.