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

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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.

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Abbreviations

CEC:

Clinical ethics consultation

CPS:

Child protection service

DNR:

Do not resuscitate

QALY:

Quality-adjusted life year

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

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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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Correspondence to Jürg C. Streuli.

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Streuli, J.C., Staubli, G., Pfändler-Poletti, M. et al. Five-year experience of clinical ethics consultations in a pediatric teaching hospital. Eur J Pediatr 173, 629–636 (2014). https://doi.org/10.1007/s00431-013-2221-2

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  • DOI: https://doi.org/10.1007/s00431-013-2221-2

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