Improving healthcare provision for children through pharmaceutical testing: The ethics of exposing a vulnerable community to unknown risks

Children can be viewed as a vulnerable community. Within medicine, the relatively new area of pediatric psychiatry has left children with mental illness as a particularly vulnerable population within healthcare provision, marginalised, and receiving sub-optimal treatment. Pharmaceutical companies have tended, and many would argue with good reason, to shy away from including children in clinical trials. However, the exclusion of children from pharmaceutical research leads pediatric mental health patients to be prescribed medication off-label, leaving them at risk as they are then treated with untested, potentially unsafe and/or unsuitable psychotropic medication. Despite the US Government's attempt to improve this deficit of pediatric treatment data through legislative procedures and to more strictly regulate pediatric pharmaceutical use, available data continues to fall far short of the ever-increasing prescription trends. With appropriate and effective treatments for this community lagging behind the adult population, mentally ill children find themselves on the margins of healthcare provision. Equal access to healthcare across the generations is of crucial import, hence the ethical question we face is: how can we improve access to the best possible medical treatment for this vulnerable community while still safeguarding their rights and not exposing them to undue risks or coercion?