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European Journal of Pediatrics

, Volume 173, Issue 5, pp 629–636 | Cite as

Five-year experience of clinical ethics consultations in a pediatric teaching hospital

  • Jürg C. StreuliEmail author
  • Georg Staubli
  • Marlis Pfändler-Poletti
  • Ruth Baumann-Hölzle
  • Jörg Ersch
Original Article

Abstract

Our retrospective study presents and evaluates clinical ethics consultations (CECs) in pediatrics as a structure for implementing hospital-wide ethics. We performed a descriptive and statistical analysis of clinical ethics decision making and its implementation in pediatric CECs at Zurich University Children’s Hospital. Ninety-five CECs were held over 5 years for 80 patients. The care team reached a consensus treatment recommendation after one session in 75 consultations (89 %) and on 82 of 84 ethical issues (98 %) after two or more sessions (11 repeats). Fifty-seven CECs recommended limited treatment and 23 maximal treatment. Team recommendations were agreed outright by parents and/or patient in 59 of 73 consultations (81 %). Initial dissensus yielded to explanatory discussion or repeat CEC in seven consultations (10 %). In a further seven families (10 %), no solution was found within the CEC framework: five (7 %) required involvement of the child protection service, and in two families, the parents took their child elsewhere. Eventual team–parent/patient consensus was reached in 66 of 73 families (90 %) with documented parental/patient decisions (missing data, n = 11). Patient preference was assessable in ten CECs. Patient autonomy was part of the ethical dilemma in only three CECs. The Zurich clinical ethics structure produced a 98 % intra-team consensus rate in 95 CECs and reduced initial team–parent dissensus from 21 to 10 %. Success depends closely on a standardized CEC protocol and an underlying institutional clinical ethics framework embodying a comprehensive set of transparently articulated values and opinions, with regular evaluation of decisions and their consequences for care teams and families.

Keywords

Pediatric ethics Parental authority Best interests of the child Decision making 

Abbreviations

CEC

Clinical ethics consultation

CPS

Child protection service

DNR

Do not resuscitate

QALY

Quality-adjusted life year

Notes

Funding source

No funding sources.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interests

All authors are or were employed by the organization studied here. No sponsoring has been received for the research, and the authors do not have any conflict of interests.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jürg C. Streuli
    • 1
    Email author
  • Georg Staubli
    • 1
  • Marlis Pfändler-Poletti
    • 1
  • Ruth Baumann-Hölzle
    • 2
  • Jörg Ersch
    • 1
  1. 1.Clinic of PediatricsUniversity Children Hospital ZurichZurichSwitzerland
  2. 2.Interdisciplinary Institute for Ethics in Health Care, Dialog EthikZurichSwitzerland

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