Paediatric clinical ethics in Australia and New Zealand: a survey

Abstract

ObjectivesTo quantify the presence, purpose, function, governance and funding of clinical ethics services (CES) in tertiary paediatric hospitals in Australia and New Zealand.Design, setting and participantsA descriptive, quantitative survey was conducted across eight paediatric hospitals.Main outcome measuresResponses from survey questions on the presence, purpose, function, governance and funding of the CES.ResultsSeven of eight tertiary paediatric hospitals identified access to CES. Regarding purpose and function, all CES provided clinical case consultation, six of seven provided education and training, six of seven assisted with organisational policy and guideline development and four of seven undertook original ethics research. There was wide variation in how case consultations were conducted, reported and documented. With respect to governance and funding, all CES reported to their hospital executive and only one CES reported having a dedicated, although small, budget.ConclusionsHeterogeneity in the process of case consultation and CES policy content exists across the organisations studied. There is consistency with the broader values that underpin CES such as their multidisciplinary nature and level of training required for key staff. There is an apparent lack of formal budgetary support from health services for CES activities, with support derived mostly from staff who contribute their time in addition to their primary roles.

Evaluation of a paediatric clinical ethics service

“…Similar to our study, empirical work has thus far mainly been descriptions of service processes and activity and feedback surveys of users of services . A small number of studies have surveyed multiple centres . This kind of data is valuable as it provides a contemporaneous picture of CES, encourages transparency and allows comparison; however, it must be interpreted carefully.…”

“…There are increasing calls to evaluate CES, credential the people that work within them and develop standards for practice . Several centres have published papers describing CES, and one explored clinicians' experience of ethics in practice, but there is a lack of reports on the evaluation of existing services using normative standards. The aim of this paper is to evaluate a newly established paediatric CES, incorporating both normative and empirical analysis.…”

‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

“… PIC questionnaire: An online questionnaire including closed yes/no, Likert-type scale and multiple-choice questions was developed by the research team, based on a literature review of published studies. 6,8,9 The questionnaire was independently pre-piloted with three medical students, an English student, a Paediatrician, and a PIC consultant (Supplemental file 1). We used convenience sampling to approach PIC consultants via the UK PICS ethics interest group to recruit one consultant per PIC. FG with DGH/GP clinicians: Consultant paediatricians/neonatologists and senior nurses working in DGH in London and the South-East were invited to participate.…”

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

“…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 ). They may vary in their make-up depending on the institution with provisions such as a formal ethics committee, informal small group-discussions or one-to-one discussions with an individual bioethicist, or a health professional with an interest in, or qualification in, bioethics ( Cottle et al, 2017 ; Kesselheim et al, 2010 ; Streuli et al, 2014 ; Thomas et al, 2015 ). In addition, in a time of rapid technological development and initiation, understanding the relationship between the clinicians and bioethics services is important, not least to guide the evolution of pertinent support for the physicians.…”