Family Connections with Pediatrics Blog
Just as most of us use some sort of GPS or maps app while driving, we also use certain morals, values, and principles to make our way through each day. Values can be shared and often connect us to each other. But sometimes values are not clear or shared. What do we do when there is uncertainty or a conflict of values between patients, families, doctors, the care team, and community?
Pediatric ethics consultation services (PECS) offer ways to respond to questions of uncertainty or conflicting values. The American Academy of Pediatrics, American Medical Association, and The Joint Commission recommend each hospital have a way to address ethics issues.1-3 PECS are most often consulted when there is disagreement about the most appropriate decision for the patient. PECS also play an important role in developing hospital policy and teaching staff and trainees about ethics.
This month’s Pediatrics features two articles entitled, ‘Pediatric Ethics Consultation Services’ (10.1542/peds.2022-058947) and ‘Pediatrics Ethics Consultations Services, Scope and Staffing’ (10.1542/peds.2022-058999) by Weaver et al, looking at ethics services in children’s hospitals across the US.
Pediatrics Ethics Consultation Services
Authors of this study wanted to learn how many children’s hospitals have PECS. From July 2020 to June 2021, the Children’s Hospital Association sent a survey to 231 children’s hospitals in the US. Of the 144 who replied, 69% reported having PECS. Here are a few of the other details found in the study:
- Hospitals focused on pediatrics (41%) were more likely to have PECS
- Hospitals that have pediatric palliative care, high-level trauma, and neonatal intensive care units (NICU) were more likely to have PECS
- Hospitals with residency training programs and connected to a medical school were more likely to have PECS
Noting that not all hospitals have access to ethics services, the authors proposed further research into the best ways to address ethics issues within children’s hospitals.
Pediatric Ethics Consultation Services, Scope, and Staffing
In this article, authors share results from a survey that looked at what ethics services are, how and by whom they are provided, and budgets. The authors contacted an ethics representative in 181 hospitals and 117 completed the survey. Here are some of the results:
- Over half (55%) of pediatric ethics consultations are provided by general hospital ethics consultants who also care for adults
- Pediatricians, nurses, social workers, and chaplains represent the most common ethics consultants
- In 65% of settings, ethics consultants are not as diverse as the patients they serve
- The majority offer services in more than one way: a small team (87%), a single individual (72%), or a full ethics committee (61%)
- Almost three-quarters (74%) do not have a budget for the ethics program
- Ethics services also includes organizational ethics (40%), research ethics (34%), or community outreach related to ethics (13%)
The survey results suggest that although the need for ethics consultation services have increased in the last decade, ethics programs lack funding and resources.
What can you do with these articles?
- Read them both to learn more about what pediatric ethics consultation services are, can and should be.
- If you are part of a hospital advisory council, share this article to talk and learn about PECS in your hospital.
- If PECS are limited or do not exist in your area, think about working with other families, doctors, and health care professionals to build diverse PECS.
Resources
- Chaet DH. AMA Code of Medical Ethics' Opinions on Ethics Committees and Consultations. AMA J Ethics. Nov 1 2016;18(5):499-500. doi:10.1001/amajethics.2018.1049
- Moon M, Committee On B. Institutional Ethics Committees. Pediatrics. May 2019;143(5)doi:10.1542/peds.2019-0659
- The Joint Commission. 2022 Comprehensive Accreditation Manual. The Joint Commission 2022
