Read the following attached PDF titled:
• Moral choices in end of life care for children by Susan Stringer. Dated September 2013 | Volume 12 | Number 7
Writer, after you read the PDF File that I have attached by Susan Stringer please answer the following four (4) questions:

1. Describe the ways the subjects were vulnerable.
2. Is there any conflict of interest?
3. Which protections should be put in place to protect these subjects from harm?
4. What are the incidence and prevalence of moral distress in nursing today?

Stringer, S. (2013). Moral choices in end of life care for children. Cancer Nursing Practice, 12(7), 27-32 6p

CANCER NURSING PRACTICE September 2013 | Volume 12 | Number 7 27
Art & science | ethics
Moral choices in end of life care for children
Susan Stringer outlines different ethical stances and how they relate to the decision whether to discuss treatment with an 11-year-old patient
End of life care is fraught with difficulties and ethical dilemmas, which are even more problematic in the case of children (Royal College of Paediatrics and Child Health 2004). Although many of the issues encountered are often unavoidable, they can be emotive (Garrard 2009). Common issues include the management of pain and other distressing symptoms, uncertainties about the future, psychosocial, emotional and spiritual concerns, and providing compassionate support for children and their families. Parents may face heart-breaking dilemmas, such as whether to continue aggressive life-sustaining treatments, which may result in unbearable suffering; or allow their child to die. This article explores a case study of an 11-year-old boy with lymphoma to illustrate the ethical considerations of the decision-making process involved in his care. Three ethical issues – beneficence, autonomy and veracity – that are pertinent to the case study and that might need to be considered when providing end of life care
to children are discussed. The main elements of each of these ethical issues are examined and their implications for clinical practice are appraised. Healthcare workers should not only acknowledge the importance of good end of life care, but should also recognise the different types of ethical issues that may arise. To put these ethical debates into context, it is necessary to establish definitions of palliative care and ethics, and consider their fundamental philosophies and perceptions. Palliative care In 1986, the World Health organization (WHo) defined palliative care as: ‘The active total care of patients whose disease is not responsive to curative treatment.’ WHo stressed the importance of controlling pain and other symptoms, and psychological, social and spiritual problems, to achieve optimum quality of life for patients and their families. Ahmedzai et al (2004) expressed concern that this definition of palliative care could be construed as ‘relegating palliative care to the last stages of care’. The provision of palliative care is not restricted to those with incurable disease; consequently the original WHo definition has been revised (WHo 2002) to include problems associated with ‘life-threatening illness’, emphasising the need to introduce palliative care earlier on in the disease process. other tenets of palliative care specified by WHo (1986) include the intention to ‘neither hasten nor postpone death’, so that dying is seen as a normal process. A further document was produced to take into account the comprehensive needs of children (WHo 1998). The aim of palliative care is to reduce physical, psychological and spiritual suffering. This is