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

Abstract

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.

Clinical ethics support services in paediatric practice: protocol for a mixed studies systematic review on structures, interventions and outcomes

“…Consultant paediatricians, trainees and residents have expressed concerns that these public cases might negatively impact their relationship with patients and families. 35 Availability of CESS for teams facing ethical challenges has been strongly advocated by professional bodies, 31 academics 33 36 37 and clinicians. 35 38 However, there are no standards or guidance on Paediatric (p)-CESS structure, functions or aims.…”

“… 35 Availability of CESS for teams facing ethical challenges has been strongly advocated by professional bodies, 31 academics 33 36 37 and clinicians. 35 38 However, there are no standards or guidance on Paediatric (p)-CESS structure, functions or aims. Nor is there agreement about the level of involvement of patients, or in paediatrics parents and children, in ethics discussions.…”

Ethical advice in paediatric care

“…We believe it essential to recognise the distinct and distinctive ethical issues arising in paediatrics. As we have reported, many UK child healthcare professionals (HCP) have ad hoc ethics support, with some in district general hospitals preferring ethical issues to be managed in tertiary centres 3…”

“…Cognisant of significant variability in ethics support for paediatric HCP,3 we suggest standards to homogenise the support available to children, families and clinical teams facing contemporary paediatric moral dilemmas.…”