title: Five-year experience of clinical ethics consultations in a pediatric teaching hospital.
abstract: 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 5 years 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.
authors: Clinic of Pediatrics, University Children Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland, streuli@ethik.uzh.ch.
authors: Jürg C
authors: JC
authors: Streuli
authors: Georg
authors: G
authors: Staubli
authors: Marlis
authors: M
authors: Pfändler-Poletti
authors: Ruth
authors: R
authors: Baumann-Hölzle
authors: Jörg
authors: J
authors: Ersch
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D017041:Ethics Committees; D033061:Ethics Consultation; D026690:Ethics, Clinical; D005260:Female; D006776:Hospitals, Pediatric; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000941:ethics*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013557:Switzerland