Follow-up to the Clinical Ethics Seminar “Principles and Values of Medical Ethics” at Susimetsa, September 18-19, 2025
On 18–19 September, the clinical ethics seminar for children’s hospitals, “Principles and Values of Medical Ethics,” took place at the Susimetsa Philosophicum in Pärnumaa. The seminar focused on discussing what child-centred medicine requires from healthcare professionals.
The seminar was organised by the University of Tartu Centre for Ethics, Tallinn Children’s Hospital, and the Children’s Clinic of Tartu University Hospital. The event was opened by Professor Margit Sutrop, Professor of Practical Philosophy at the University of Tartu, with a lecture entitled “Values and Ethical Choices in Everyday Medical Practice.”
At the symposium “Ethical and Legal Aspects of Treating the Child Patient,” Professor Tuuli Metsvaht, Head of the Children’s Clinic at Tartu University Hospital, and Liis Toome (PhD), Member of the Management Board and Medical Director of Tallinn Children’s Hospital, discussed how to ensure funding for extremely expensive treatments for rare diseases within a solidarity-based healthcare system. A key question addressed was: who makes the decision regarding treatment funding? Two clinical cases were presented in which a child was already receiving or about to receive highly expensive gene therapy. The legal perspective was provided by Attorney-at-Law Ants Nõmper (PhD), Managing Partner at Ellex Raidla.
At the symposium “Medical and Ethical Aspects of Paediatric Palliative Care,”Rael Laugesaar, physician-lecturer at the Children’s Clinic of Tartu University Hospital, spoke about paediatric palliative care from the perspective of a child neurologist.
Kadri Saks, Head of the Haematology and Oncology Department at Tallinn Children’s Hospital, gave a presentation entitled “What to Do When There Is Nothing More to Be Done?” The presentation by Katri Aaslav-Tepandi, Advisor–Chief Chaplain at the Ministry of Social Affairs and Head of the Paediatric Palliative Care Working Group, addressed supporting the child and family throughout the treatment journey and decision-making processes.
On the second day of the seminar, the symposium “Autonomy, Privacy, and Human Dignity of the Child Patient” took place, where Professor Kadri Simm, Professor of Practical Ethics at the University of Tartu, and Kristi Paron (PhD), Senior Advisor to the Chancellor of Justice, discussed various aspects of child patient autonomy.
A presentation by Ülle Rohi, Head of the Quality Department at Tallinn Children’s Hospital, focused on a practical case: what information should be recorded in a child’s health data under social history, and how can discrimination or stigmatisation in adulthood be avoided? The seminar also explored different methods for resolving ethical cases in hospitals, collaboration and mutual expectations between physicians, patients, and their families, professional empathy, and patient autonomy. Representatives of the Tallinn Children’s Hospital Children’s and Families Advisory Council, Livia Laas and Kristi Peegel, also participated in these discussions.
Halliki Harro-Loit, Professor of Journalism at the University of Tartu, conducted a practical workshop on dialogical ethics in communication between physicians, children, and parents. Kristi Lõuk, doctoral student at the University of Tartu and project manager at the Centre for Ethics, organised various values-based games.
“The training was very necessary, and I would recommend it to everyone. I hope that these seminars will continue in the future,” said Gerda Ainsoo, haematologist-oncologist at the children’s hospital. She added that such a seminar provides an opportunity to step away from everyday work and encourages reflection on important topics. “It was possible to explore these issues in depth together with lecturers and colleagues. Excellent speakers such as Kristi Paron, Katri Aaslav-Tepandi, and Halliki Harro-Loit should also come to give lectures at the children’s hospital,” Ainsoo noted.
“During the Susimetsa seminar, many new ideas emerged, particularly regarding the weighing and justification of certain treatment decisions. Making treatment decisions with the help of different ethical principles provides additional clarity.
The legal dimension and its connection to ethics and patient autonomy, viewed from a lawyer’s perspective, was also very interesting, as paediatric patients are generally those who (not yet) can make decisions about their own health.
The seminar was well organised, and the presentations were engaging and thought-provoking. I would definitely recommend that all physicians participate in such an ethics seminar at least once during their career,” said Helen Pärna, paediatric cardiologist at the children’s hospital.
“The speakers at the ethics seminar were extremely inspiring, the tasks provided were challenging, and I was more than satisfied with the seminar. In paediatric training, we often experience and learn to think by following our mentors’ example: when nothing more can be done, what else could still be done?
I feel that seeing the world through the lens of ethical principles has accompanied me not only in my clinical work but also in everyday life,” described Marie Kaivo, paediatrician.
“A year ago, I participated in a highly engaging ethics seminar at Susimetsa that addressed ethical dilemmas in adult medicine. This made me once again keenly aware that issues in paediatric healthcare have a distinct character of their own. Last year’s idea to organise an ethics seminar together with Professor Margit Sutrop’s team for colleagues from our hospital and the Tartu Children’s Clinic has now become a reality. I have received feedback from colleagues that while some attended the seminar with a degree of reservation and hesitation, these feelings dissipated within the first hours—thanks both to the magical environment of the Susimetsa Philosophicum and the content-rich programme with inspiring lecturers and discussions. I am pleased that, in addition to physicians, nurses, a physiotherapist, a quality manager, a chaplain, and parents from our hospital also participated. If there is energy and inspiration, then certainly ‘Susimetsa Philosophicum, Ethics and Children – Part 2’ should follow!” added Liis Toome.
Source: Tallinn Children’s Hospital intranet
*Original version in Estonian below. This is a translation made using ChatGPT.
Eesti keeles
Järelkaja kliinilise eetika seminarile „Meditsiinieetika printsiibid ja väärtused“ Susimetsas
18.–19. septembril toimus Susimetsa Philosophicumis Pärnumaal lastehaiglate kliinilise eetika seminar „Meditsiinieetika printsiibid ja väärtused,“ et arutleda selle üle, mida eeldab tervishoiutöötajatelt lapsekeskne meditsiin.
Seminari korraldasid Tartu Ülikooli eetikakeskus, Tallinna Lastehaigla ja Tartu Ülikooli Kliinikumi lastekliinik. Seminari juhatas sisse TÜ praktilise filosoofia professor Margit Sutrop loenguga „Väärtused ja eetilised valikud meditsiini argipäevas“.
Sümpoosiumil „Lapspatsiendi ravi eetilised ja juriidilised aspektid“ arutlesid TÜK lastekliiniku juhataja prof Tuuli Metsvaht ja Tallinna Lastehaigla juhatuse liige – ravijuht Liis Toome (PhD) teemal, kuidas tagada ülikallite harvikhaiguste ravijuhtude rahastus solidaarsustervishoiu valguses – kes teeb otsuse ravi rahastuse osas? Esitamisele tuli kaks ravijuhtu, kus laps juba saab või on saamas ülikallist geeniravi. Juriidilise vaatenurga esitas vandeadvokaat ja Ellex Raidla juhtivpartner Ants Nõmper (PhD).
Sümpoosiumil „Lapspatsiendi palliatiivravi meditsiinilised ja eetilised aspektid“ kõneles TÜK lastekliiniku arst-õppejõud Rael Laugesaar laste palliatiivravist lasteneuroloogi pilgu läbi.
Tallinna Lastehaigla hematoloogia ja onkoloogia osakonna juhataja Kadri Saks tegi ettekande teemal „Mida teha, kui enam midagi teha ei ole?“. Sotsiaalministeeriumi nõunik-peakaplan, laste palliatiivse ravi töörühma juht Katri Aaslav-Tepandi ettekanne käsitles lapse ja pere toetamist raviteekonnal ja -otsustes.
Seminari teisel päeval toimus sümpoosium „Lapspatsiendi autonoomia, privaatsus ja inimväärikus,“ kus TÜ praktilise eetika professor Kadri Simm ja õiguskantsleri vanemnõunik Kristi Paron (PhD) käsitlesid lapspatsiendi autonoomia erinevaid küsimusi.
Tallinna Lastehaigla kvaliteediosakonna juhataja Ülle Rohi ettekanne käsitles praktilist kaasust: Kas ja mida peaks lapse terviseandmetes sotsiaalses anamneesis kajastama? Kuidas vältida diskrimineerimist või stigmatiseerimist täiskasvanueas?
Veel vaeti seminaril haiglate eetiliste kaasuste lahendamise erinevate meetodite üle, arstide ja patsientide ning nende omaste koostööd ja vastastikusi ootusi, professionaalset empaatiat ja patsiendi autonoomiat – nendes aruteludes osalesid ka Tallinna Lastehaigla laste ja perede nõukoja esindajad Livia Laas ja Kristi Peegel.
TÜ ajakirjandusprofessor Halliki Harro-Loit viis läbi praktilise seminari dialoogilisest eetikast arstide suhtlemisel laste ja vanematega. TÜ doktorant ja eetikakeskuse projektijuht Kristi Lõuk korraldas erinevaid väärtusmänge.
„Koolitus oli väga vajalik ja soovitan seda kõigile. Loodan, et need seminarid jätkuvad ka edaspidi,“ ütles lastehaigla hematoloog-onkoloog Gerda Ainsoo. Ta lisas, et selline seminar annab võimaluse igapäeva tööst välja lülitada, innustades kaasa mõtlema tähtsatel teemadel. „Oli võimalik koos lektorite ja kolleegidega nende teemadega sügavuti minna. Suurepärased lektorid nt Kristi Paron, Katri Aaslav-Tepandi, Halliki Harro-Loit peaksid tulema ka lastehaiglasse loenguid pidama,“ ütles Ainsoo.
„Susimetsa seminari käigus tekkis palju uusi mõtteid eelkõige teatud raviotsuste kaalutlemise ja põhjendamise osas. Erinevate eetikaprintsiipide abil raviotsuste tegemine annab täiendavat selgust.
Väga põnev oli ka seadusandluse pool ja selle seostamine eetika ja patsiendi autonoomiaga juristi nägemuses, kuna lastearsti patsiendid on üldiselt need, kes ise (veel) midagi oma tervise osas otsustada ei saa.
Seminar oli hästi korraldatud, ettekanded olid kaasahaaravad ja mõtlemapanevad. Kindlasti soovitaksin sellisel eetikaseminaril osaleda kõikidel arstidel vähemalt korra oma karjääri jooksul,“ ütles,“ ütles lastehaigla lastekardioloog Helen Pärna.
„Eetikaseminari esinejad olid äärmiselt inspireerivad, lahendamiseks antud ülesanded väljakutsuvad ja jäin seminariga üle ootuste rahule. Lastearsti õppes kogeme ja õpime mõtlema oma juhendajate eeskujul enamasti selliselt, et kui enam midagi teha ei saa, siis mida ikkagi veel teha saaks.
Tunnen, et võtsin läbi eetiliste printsiipide maailma nägemise kaasa mitte ainult kliinilisse töösse, aga ka igapäevaellu,“ iseloomustas seminari taset lastearst Marie Kaivo.
„Aasta tagasi osalesin Susimetsas äärmiselt paeluval eetikaseminaril, kus käsitleti eetilisi dilemmasid täiskasvanute meditsiinis. Nii tundsin jällegi teravalt, et laste tervishoius kerkivad küsimused on selge iseärasusega. Aastatagune idee korraldada prof Margit Sutropi meeskonnaga eetikaalane seminar meie haigla ja Tartu lastekliiniku kolleegidele saigi teoks. Olen saanud meie kolleegidelt tagasisidet, et kui seminarile mindi teatud reserveerituse ja kõhklusega, siis need meeleolud taandusid esimestel tundidel – kaasa aitas nii Susimetsa Philosophicumi maagiline miljöö kui ka sisutihe päevakava inspireerivate lektorite ja aruteludega. Mul on heameel, et arstide kõrval osalesid meie haiglast ka õed, füsioterapeut, kvaliteedijuht, hingehoidja ja lapsevanemad. Kui jaksu ja inspiratsiooni on, siis kindlasti tuleb „Susimetsa Philosophicum, eetika ja lapsed – Osa 2“!“ lisas Liis Toome.
