title: Ethics consultation in pediatrics: long-term experience from a pediatric oncology center.
abstract: There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000-2011) at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is needed on the role of ethics consultation in pediatrics.
authors.affiliation: a St. Jude Children's Research Hospital.
authors.forename: Liza-Marie
authors.initials: LM
authors.lastname: Johnson
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Church
authors.forename: Monika
authors.initials: M
authors.lastname: Metzger
authors.forename: Justin N
authors.initials: JN
authors.lastname: Baker
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003657:Decision Making / Q000941:ethics*; D028744:Ethics Committees, Research; D033061:Ethics Consultation; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D028681:Moral Obligations; D017008:Negotiating; D010166:Palliative Care / Q000941:ethics; D010290:Parents; D010372:Pediatrics / Q000941:ethics*; D026684:Personal Autonomy; D012189:Retrospective Studies; D018570:Risk Assessment; D013714:Tennessee
keywords: autonomy; conflict resolution; decision making; ethics consultation; pediatric hospital; risk–benefit assessment