Development and Retrospective Review of a Pediatric Ethics Consultation Service at a Large Academic Center

Leland, Brian D.; Wocial, Lucia D.; Drury, Kurt; Rowan, Courtney M.; Helft, Paul R.; Torke, Alexia M.

doi:10.1007/s10730-020-09397-6

Cited by 16 publications

(4 citation statements)

References 24 publications

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“…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. Fortunately, nurses consider formal ethics support as helpful in resolving moral distress.…”

Section: Discussionmentioning

confidence: 99%

Ethical climate and moral distress in paediatric oncology nursing

Ventovaara¹,

Sandeberg

Räsänen

et al. 2021

Nurs Ethics

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Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.

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Section: Discussionmentioning

confidence: 99%

Ethical climate and moral distress in paediatric oncology nursing

Ventovaara¹,

Sandeberg

Räsänen

et al. 2021

Nurs Ethics

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“…As Linney et al (2019) suggest, it can take time to access bioethics support, and time to resolve difficult ethical issues. Bioethics services that are more agile, whether they contain large committees or consist of smaller, more ad hoc ethical discussions, seem to be more valued where they are available ( Leland et al, 2020 ). In wider discussions about the ethical climate in PICU, a core contributor to a positive ethical climate was the facilitation of equal involvement of interdisciplinary professionals in ethical discussions about the care of children with technology dependence in PICU ( Moynihan et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…One important means of navigating the challenges surrounding the decision whether to initiate technology dependence may be by the inclusion of bioethics services in the discussions ( Johnson et al, 2015 ; Kesselheim et al, 2010 ; Morrison et al, 2015 ). The bioethics services aim to aid clinicians to make decisions by ensuring that current national and international ethical guidelines and frameworks are recognized and adhered to in discussions ( Leland et al, 2020 ; Thomas et al, 2015 ); as well as to help mediate where there are differences in opinion between clinicians and the family of the child ( Morrison et al, 2015 ). Access to bioethics services, however, is not consistent internationally, nor across different national hospital sites ( McDougall & Notini, 2016 ; Morrison et al, 2015 ; Thomas et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

The Meaning Given to Bioethics as a Source of Support by Physicians Who Care for Children Who Require Long-Term Ventilation

et al. 2022

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The role and potential of bioethics input when a child requires the initiation of technology dependence to sustain life is relatively unknown. In particular, little is understood about the meaning physicians give to bioethics as a source of support during the care of children in pediatric intensive care who require long-term ventilation (LTV). We used a hermeneutic phenomenological approach to underpin the collection and analysis of data. Unstructured interviews of 40 physicians in four countries took place during 2020. We found that elements of trust, communication and acceptance informed the physicians’ perceptions of the relationship with bioethics. These ranged from satisfaction to disappointment with their input into critical decisions. Bioethics services have potential to help physicians gain clarity over distressing and complex care decisions, yet physicians perceive the service inconsistently as a means of support. This research provides a sound basis to guide more beneficial interactions between clinicians and bioethics services.

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“…З нашої точки зору, ще недостатньо досліджені біоетичні проблеми низькорослих дітей, зокрема з дефіцитом гормону росту (ДГР). У розвинених країнах консультації з питань педіатричної етики стають рутинною практикою багатьох дитячих лікувальних закладів [7,8]. В Україні цю роботу покладено на локальні етичні комі-УДК 616.432-008.…”

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Bioethical, medical, and social problems in children with growth hormone deficiency

Aryayev,

Senkivska

2024

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Background. Medical and practical advancements have brought about new possibilities for providing healthcare to people, but with it comes new bioethical challenges. In many pediatric medical institutions, consultations on pediatric ethics have become common practice. However, the bioethical problems related to short children have not been studied enough yet. The purpose of this study is to identify and analyze bioethical, medical, and social issues in children with growth hormone deficiency (GHD), which can potentially hinder timely diagnosis and adherence to replacement therapy. Materials and methods. The identification of bioethical, medical, and social problems was conducted at the Odesa Regional Children’s Hospital between 2012 and 2020. The study involved a cohort of 94 children with GHD and short stature (SDS 3.4 ± 0.1), aged 7.2 ± 0.4 years, as well as their parents (124 individuals). The study was based on a questionnaire survey, history taking, interviews, objective examination of patients, and analysis of medical records. Results. The study found evidence of violations of the Hippocratic principle of help and assistance (“do good”) in the form of delayed or incorrect diagnosis in 10.6 % of cases and incomplete adherence to local protocols for managing sick children in 6.4 % of cases. Violations of the Hippocratic principle of non-harm (“first, do no harm”) were evidenced by adverse events (16.0 %) and serious adverse events (3.2 %) during replacement therapy. Children with GHD were subject to violations of social justice, such as neglect (8.5 %), socio-economic problems in the family (12.8 %), and external environmental restrictions (9.6 %). Violations of the personal autonomy of children with GНD included physical and psychological abuse in the family (29.8 and 38.3 % of cases, respectively), stigmatization (25.5 %), school bullying (27.2 %), medical neglect (5.3 %), medical paternalism (6.4 %), and overprotection (10.6 %). Conclusions. In the management of children with GHD, various bioethical, medical, and social issues have come to light. Low adherence to recombinant human growth hormone therapy can be considered an independent bioethical problem associated with medical paternalism and medical neglect.

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Development and Retrospective Review of a Pediatric Ethics Consultation Service at a Large Academic Center

Cited by 16 publications

References 24 publications

Ethical climate and moral distress in paediatric oncology nursing

Ethical climate and moral distress in paediatric oncology nursing

The Meaning Given to Bioethics as a Source of Support by Physicians Who Care for Children Who Require Long-Term Ventilation

Bioethical, medical, and social problems in children with growth hormone deficiency

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