Five-year experience of clinical ethics consultations in a pediatric teaching hospital
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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.
KeywordsPediatric ethics Parental authority Best interests of the child Decision making
Clinical ethics consultation
Child protection service
Do not resuscitate
Quality-adjusted life year
No funding sources.
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.
- 4.American Academy of Pediatrics (2003) Family pediatrics: report of the task force on the family. Pediatrics 111:1541–1571Google Scholar
- 6.Aulisio MP, Arnold RM, Youngner SJ (2000) Health care ethics consultation: nature, goals, and competencies: a position paper from the Society for Health and Human Values–Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation. Ann Intern Med 133:59–69PubMedCrossRefGoogle Scholar
- 8.Baumann-Hölzle R (2009) “7 Schritte Dialog”—Exemplarische Vertiefung der Methodik einer Fallbesprechung. In: Baumann-Hölzle R, Arn C (eds) Ethiktransfer in Organisationen. EMH/Schwabe, Basel, pp 215–266Google Scholar
- 9.Baumann-Hölzle R, Waldvogel K, Staubli G, Maguire C, Bänziger O, Huber Y, Sennhauser F (2009) Implementierung—“7 Schritte dialog” im Rahmen des Ethik-forums am Kinderspital Zürich. In: Baumann-Hölzle R, Arn C (eds) Ethiktransfer in Organisationen. EMH/Schwabe, Basel, pp 255–266Google Scholar
- 18.De Lourdes Levy M, Larcher V, Kurz R, Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP) (2003) Informed consent/assent in children. Statement of the Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP). Eur J Pediatr 162:629–633PubMedCrossRefGoogle Scholar
- 28.Ramsauer T, Frewer A (2009) Clinical ethics committees and pediatrics. An evaluation of case consultations. Diametros 22:90–104Google Scholar