Emergency Medicine (2001) 13, 344–350 Blackwell Science Asia Paediatric Emergency Medicine Ethical relationships in paediatric emergency medicine: Moving beyond the dyad John Bridges, 1 Ralph Hanson, 2 Miles Little, 3 Alison Choy Flannigan, 4 Michael Fairley 5 and Leigh Haywood 6 1 Department of Economics, Case Western Reserve University, Cleveland, Ohio, United States of America, 2 Information Services, New Children’s Hospital, 3 Centre for Values, Ethics and the Law in Medicine, University of Sydney, 4 Blake Dawson Waldron Solicitors, 5 Prince of Wales Hospital and Sydney Children’s Hospital, Sydney, and 6 Ben Gelin Solicitors, Bathurst, New South Wales, Australia Abstract Most areas of health-services research concentrate on a dyadic relationship between doctor and patient. In paediatric emergency medicine it may be necessary to focus on a more complicated relationship because the parents of the child play an important role in the delivery of medical services. This paper discusses the ethical principles in paediatric emergency medicine from the perspective of five disciplines: health economics, paedi- atrics, medical ethics, law and mental health. The general consensus is that the traditional dyadic model is inadequate and that a more complicated relationship is needed for the paediatric emergency setting, such as triadic, multiple-dyadic or polyadic. Such models allow the inclusion of the parents and possibly other family members, medical providers and community members. If the paediatric setting is considered in such a framework, it may be possible to deliver a more socially beneficial medical service. Key words: economics, emergency medicine, ethics, law, paediatrics. Introduction Most areas of health services and medical research concentrate on a dyadic relationship between the doctor and patient. This is based upon the traditional view of a dyad in ethics (a dyad being defined as ‘a pair of persons in an interactional situation, e.g. patient and therapist, husband and wife’). 1 Recent research, however, has highlighted the need to look at a broader relationship in paediatric emergency medicine. 2,3 The obvious extension of the ethical rela- tionship in the paediatric setting is the inclusion of one or more of the parents in a triadic (doctor–parent– patient) relationship. Further extensions, however, can also be considered. This paper considers the ethical relationship in paediatric emergency medicine from Correspondence: Mr John F P Bridges, Lecturer of Economics, Weatherhead School of Management, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio, 44106–7206 USA. Email: healtheconomics@hotmail.com John Bridges BEc(Hons), MEc(Hons), Lecturer; Ralph Hanson, MBBCH, MPH, FRACP, FACEM, Director, Information Services; Miles Little, MD, MS, Director, Centre for Values, Ethics and the Law in Medicine, Emeritus Professor; Alison Choy Flannigan, BA LLB(Hons), Senior Associate Solicitor; Michael Fairley, MB BS, FRANZCP, Paediatrician; Leigh Haywood, LLB, Associate Solicitor.