The Ethicist - The Anesthesiologist’s Game - Question - NYTimes.com

I am an anesthesiologist. A few of my patients are children undergoing their first surgery — understandably nervous, sometimes in tears. Medications can calm them; developing a rapport with them also helps. One way I do that is to propose a contest. If they can pop the "balloon" (the bag an anesthetized patient uses to breathe), they will win a fabulous prize — a pony, a puppy, a motorcycle. This task is effectively impossible (but their deep breathing puts them to sleep faster). Some nurses complain that children in the recovery room are very disappointed when told they did not win a prize. Should I suspend the contest? MARK ISAAC, MANSFIELD, OHIO

Wait a second: I'm not getting a pony?

Fine. I knew we were only playing. Some young patients, unfortunately, do not, as their post-op responses confirm. Your admirable efforts to ease their fears, although effective in the short term, can soon disappoint these kids and, worse still, undermine their trust in doctors, rendering them yet more anxious the next time they're in a hospital. Thus, while you need not suspend your contest, you should revise it.

It is fine to engage children in a calming game, but there is a difference between a game and a lie. In the former, all participants know they are playing; in the latter, some do not. (Many parents face a version of this situation: the Tooth Fairy Problem. When must a parent honestly explain where that pillow money comes from?) Age is a big factor. Older kids can often understand what younger kids cannot. You might try less-competitive games with younger patients or promise more modest prizes that you can actually deliver — inexpensive toys or games, for example. If your hospital has child psychologists or social workers on staff, they might suggest other ways to soothe fearful children.

http://www.nytimes.com/2010/10/17/magazine/17FOB-Ethicist-t.html?ref=magazine