Pediatric Palliative Care and Pediatric Medical Ethics: Opportunities and Challenges

Abstract

The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. At the same time, the personal and professional relationships between PPC and PME present challenges, including potential conflict with colleagues, perceived or actual bias toward a palliative care perspective in resolving ethical problems, potential delay or underuse of PME services, and a potential undervaluing of the medical expertise required for PPC consultation. We recommend that these challenges be managed by: (1) clearly defining and communicating clinical roles of PPC and PME staff, (2) developing questions that may prompt PPC and PME teams to request consultation from the other service, (3) developing explicit recusal criteria for PPC providers who also provide PME consultation, (4) ensuring that PPC and PME services remain organizationally distinct, and (5) developing well-defined and broad scopes of practice. Overall, the rich relationship between PPC and PME offers substantial opportunities to better serve patients and families facing difficult decisions.

Pediatric palliative care in the community

“… Despite appreciable overlap in the fields of Pediatric Palliative Care and Ethics, we believe that Pediatric Palliative Care consultation should be a distinct event that is mutually exclusive from Ethics Committee consultation (Feudtner & Nathanson 2014).…”

When Parents Have Misunderstandings About the Risks and Benefits of Palliative Surgery

“…This case was difficult not because the parents were unclear of their goals but rather precisely because they were clear of their view of what by guest on July 10, 2020 www.aappublications.org/news Downloaded from was best but were unsure of how to achieve it. 3 They knew that their child was going to die. They wanted to spare their child pain.…”

Cuidado paliativo pediátrico

“…se les brindaba un manejo orientado a mejorar su confort antes de morir. Este último, justamente, más adelante sería entendido como cuidado paliativo pediá-trico [7].…”

“…El primero de ellos fue la aparición de las órdenes de no reanimación, lo cual, a la vez que generó un amplio debate sobre el derecho de los padres en las decisiones que involucran a sus hijos, sirvió como puerta de entrada para el debate médi-co y ético para determinar a qué personas se les debía dar un manejo paliativo y cómo debían ser tratadas [7].…”