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Ethical climate in contemporary paediatric intensive care
  1. Katie M. Moynihan1,2,3,
  2. Lisa Taylor4,
  3. Liz Crowe5,
  4. Mary-Claire Balnaves6,
  5. Helen Irving3,7,
  6. Al Ozonoff2,8,
  7. Robert D. Truog9,10,
  8. Melanie Jansen3,11
  1. 1Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  3. 3School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  4. 4Office of Ethics, Boston Children's Hospital, Boston, Massachusetts, USA
  5. 5Department of Pediatric Intensive Care, Queensland Children's Hospital, South Brisbane, Queensland, Australia
  6. 6School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
  7. 7Centre for Children’s Health Ethics and Law, Children’s Health Queensland, Brisbane, Queensland, Australia
  8. 8Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
  9. 9Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
  10. 10Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  11. 11Department of Pediatric Intensive Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  1. Correspondence to Dr Katie M. Moynihan, Cardiology, Boston Children's Hospital, Boston, MA 02115, USA; katie.moynihan{at}cardio.chboston.org

Abstract

Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC.

  • children
  • ethics committees/consultation
  • health care for specific diseases/groups
  • health personnel
  • interests of health personnel/institutions

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Footnotes

  • Twitter @drkatiemoynihan, @drmjansen

  • Collaborators Roxanne Kirsch, Lucia Wocial, Brian Leland, Gillian Colville and Rouven Porz for the Ethical Climate Collaborative (ECC).

  • Contributors KMM and LT conceptualised and designed the proposed conceptual framework, drafted the initial manuscript and reviewed and revised the manuscript. LC and M-CB, and HI and RT revised and modified the conceptual framework and edited the manuscript for important intellectual content. AO created the survey tool for external expert feedback and edited the manuscript for important intellectual content. MJ conceptualised and designed the proposed conceptual framework and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data availability statement There are no data in this work

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