Ethics Consultation in Pediatrics: Long-Term Experience From a Pediatric Oncology Center

Abstract

There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000–2011) at St. Jude Children’s Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician’s fiduciary responsibility to the patient. Non-patient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision-making among multiple stakeholders and further prospective research is needed on the role of ethics consultation in pediatrics.

What kinds of cases do paediatricians refer to clinical ethics? Insights from 184 case referrals at an Australian paediatric hospital

“…Any hospital staff member can refer a case for clinical ethics consultation. However, as has been reported at some other paediatric centres8 10 almost all referrals come from senior paediatricians.…”

“…In a Swiss study of 95 cases, ICU and rehabilitation were the most prominent departments 13. Other large case sets are from a hospital primarily treating oncology patients10 or report in terms of ‘primary diagnosis’9 or ‘place of consult’11 rather than referring department.…”

“…Recently, several paediatric-specific studies have also been published, primarily from the US context 9–14. Three themes that emerge from existing studies are the large proportion of case referrals for children less than a year old,7–9 13 14 the diversity of case typologies used,9 10 15 16 and the way in which the case sets vary depending on the nature and focus of the hospital 10 17…”

International Access to Clinical Ethics Consultation via Telemedicine

“…Community hospitals face ethical dilemmas [10], as do rural hospitals [11]. Additionally, clinical ethics dilemmas occur in a wide variety of specialties, including neurology [12], organ donation and transplantation [13], pediatrics [14], and intensive care medicine [15]. Some of these dilemmas need urgent resolution [16], and thus timely access to skilled CEC is valuable.…”

Strategies to Improve Health Care Ethics Consultation: Bridging the Knowledge Gap

“…Much has changed since 2000, when the prior national study was completed. More recent studies have examined HCEC practices in a single US institution [16][17][18][19][20][21], at institutions outside the US [22][23][24][25][26], and at 44 children's hospitals [27]. But none of these studies can be used to draw conclusions about general hospitals in the US.…”