Content review of pediatric ethics consultations at a cancer center

Abstract

Background/objectives Ethical challenges in pediatric oncology arise at every stage of illness. However, there are sparse data on the content of and reason for ethics consultations in the field. We sought to evaluate the content and characteristics of ethics consultations in pediatric patients at a cancer center. Design/methods We retrospectively identified ethics consultations performed for patients diagnosed with cancer at ≤21 years of age who were treated in the Department of Pediatrics from 2007 to 2017. Using an established coding schema, two independent reviewers analyzed the content of ethics consultation notes and identified core ethical issues and relevant contextual issues. Demographic, clinical, and consultation‐specific data were also collected. Results Thirty‐five consultations were performed for 32 unique patients. The most commonly identified ethical issues were obligation to provide nonbeneficial treatment (29%) and resuscitation preferences (26%). Communication conflicts were the most commonly identified contextual issue (40%). There were two themes that emerged repeatedly but were not a part of the original coding schema—four consultations (11%) that involved physicians questioning their obligation to provide potentially toxic treatment in the setting of poor patient/parent compliance, and two consultations (6%) related to complex risk‐benefit analysis in the setting of an invasive procedure with uncertain benefit. Conclusions Pediatric ethics consultations are infrequent at this specialty cancer hospital. Ethical issues focused on treatment and end‐of‐life care and included a diversity of communication conflicts.

Ethical climate and moral distress in paediatric oncology nursing

“…Facilitated ethics discussions and clinical ethics support services can aid care teams to clarify complex ethical problems. 31 Winter et al 32 found paediatric ethics consultations as rare, but when requested, they most often concerned issues related to non-beneficial treatments. According to Leland et al, 33 many paediatric ethics consultations involve provider moral distress.…”

COVID-19–Related Ethics Consultations at a Cancer Center in New York City: A Content Review of Ethics Consultations During the Early Stages of the Pandemic

“…Two independent reviewers analyzed the content of each ethics consultation note using an established schema developed to standardize the ethics consultation process and outcomes. 4 The reviewers (D.N.F., L.B., Y.A.) assessed primary, secondary, and tertiary ethical issues on the basis of the narrative portion of the consultant's note.…”

El hermano del niño con cáncer merece ser visible

“…Lo anterior se convierte en un desafío para los profesionales de la salud, quienes, no solo en la práctica, sino también en la investigación, han desatendido las necesidades del hermano sano y quienes, en el marco del hacer el bien y la justicia, deben propender a reivindicar los derechos de dicha población por considerarse también vulnerable y afectada por la situación de cáncer infantil [52]. Asimismo, en el marco de la bioética en salud, el llamado es a evitar las aproximaciones reduccionistas a los complejos problemas que enfrentan los sujetos y las comunidades de cuidado, por tanto, en el área del cáncer infantil debe considerarse la afectación sistémica de los actores implicados, entre ellos, los hermanos sanos [53].…”