Abstract
Progress in pediatric surgery has relied primarily on the diffusion of innovations as reported in case series in the literature. The standards applied to clinical research that predominate in medical specialties have not become common in surgery, despite agreement that comparative trials produce the best evidence. Many pediatric surgical interventions compete with similar or even radically different surgical and medical approaches to the same condition. The resulting confusion about how to proceed raises serious ethical questions for physicians and families facing major decisions about surgery, medical therapy, or comfort care. Pediatric surgeons have a moral obligation to undertake formal research comparing their preferred operations to alternative approaches.
