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. Nonpatient 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 that 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.

Keywords:

• ethics consultation
• decision making
• conflict resolution
• autonomy
• risk–benefit assessment
• pediatric hospital

ACKNOWLEDGMENT

We acknowledge (1) Kathleen T. Oldread, MD, who assisted in directed content analysis, but not article preparation, (2) David Galloway and Sharon Naron of scientific editing at St. Jude Children's Research hospital, who added valuable comments and editing to this article, and (3) April Coan, MPH, and Ying Yuan, PhD, of biostatistics who assisted with data analysis.

Funding

Supported in part by American Lebanese Syrian Associated Charities (ALSAC) and the Hospital Ethics Committee at St. Jude Children's Research Hospital, neither of which had any role in planning, conduct, analysis, or reporting of this article.