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Five-year experience of clinical ethics consultations in a pediatric teaching hospital

Streuli, Jürg ; Staubli, Georg ; Pfändler-Poletti, Marlis ; Baumann-Hölzle, Ruth ; Ersch, Jörg

In: European Journal of Pediatrics, 2014, vol. 173, no. 5, p. 629-636

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    Title
    • Five-year experience of clinical ethics consultations in a pediatric teaching hospital
    Author
    • Streuli, Jürg. Clinic of Pediatrics, University Children Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
    • Staubli, Georg. Clinic of Pediatrics, University Children Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
    • Pfändler-Poletti, Marlis. Clinic of Pediatrics, University Children Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
    • Baumann-Hölzle, Ruth. Interdisciplinary Institute for Ethics in Health Care, Dialog Ethik, Schaffhauserstrasse 418, 8050, Zurich, Switzerland
    • Ersch, Jörg. Clinic of Pediatrics, University Children Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • European Journal of Pediatrics, 2014, vol. 173, no. 5, p. 629-636. Springer Berlin Heidelberg
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:325886
    Summary
    Our retrospective study presents and evaluates clinical ethics consultations (CECs) in pediatrics as a structure for implementing hospital-wide ethics. We performed a descriptive and statistical analysis of clinical ethics decision making and its implementation in pediatric CECs at Zurich University Children's Hospital. Ninety-five CECs were held over 5years for 80 patients. The care team reached a consensus treatment recommendation after one session in 75 consultations (89%) and on 82 of 84 ethical issues (98%) after two or more sessions (11 repeats). Fifty-seven CECs recommended limited treatment and 23 maximal treatment. Team recommendations were agreed outright by parents and/or patient in 59 of 73 consultations (81%). Initial dissensus yielded to explanatory discussion or repeat CEC in seven consultations (10%). In a further seven families (10%), no solution was found within the CEC framework: five (7%) required involvement of the child protection service, and in two families, the parents took their child elsewhere. Eventual team-parent/patient consensus was reached in 66 of 73 families (90%) with documented parental/patient decisions (missing data, n = 11). Patient preference was assessable in ten CECs. Patient autonomy was part of the ethical dilemma in only three CECs. The Zurich clinical ethics structure produced a 98% intra-team consensus rate in 95 CECs and reduced initial team-parent dissensus from 21 to 10%. Success depends closely on a standardized CEC protocol and an underlying institutional clinical ethics framework embodying a comprehensive set of transparently articulated values and opinions, with regular evaluation of decisions and their consequences for care teams and families.