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Not just little adults: a review of 102 paediatric ethics consultations
Stefanie M Thomas1, Paul J Ford, Kathryn L Weise
1Department of Pediatric Hematology/Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH, USA.
Insights
This study reviewed pediatric ethics consultations, finding that end-of-life issues were the most common reason for consultation, particularly in younger male patients. Further research on pediatric ethics consultation is needed.
Area of Science:
- Pediatric Medical Ethics
- Clinical Ethics Consultation
- Healthcare Decision-Making
Background:
- The American Academy of Pediatrics emphasizes the significance of pediatric ethics consultation.
- Limited published data exists on the practical application of ethics consultation in pediatrics.
- Understanding the scope of pediatric ethics consultations is crucial for professional development.
Purpose of the Study:
- To retrospectively analyze and characterize the topics addressed in a substantial sample of clinical ethics consultations within pediatric medicine.
- To provide descriptive statistics on patient demographics, consultation reasons, and consultant impact.
Main Methods:
- A review of 102 clinical ethics consultations for patients under 18 years old from January 2005 to July 2013.
- Descriptive statistical analysis of patient characteristics and consultation drivers.
- Comparative analysis of patient subgroups using statistical tests (Wilcoxon's rank sum, chi-square, logistic regression).
Main Results:
- The majority of consultations (102) originated from intensive care units and were physician-initiated.
- End-of-life issues represented the most frequent reason for ethics consultations.
- Younger age and male gender were significantly associated with end-of-life consultations (p < 0.001 and p = 0.010, respectively).
Conclusions:
- This study offers valuable insights into the nature of consultations in pediatric ethics.
- The findings underscore the need for continued empirical research in pediatric ethics consultation.
- This data supports the ongoing professionalization of clinical ethics consultation services.
Aim:
The American Academy of Pediatrics statement on institutional ethics committees highlights the importance of paediatric ethics consultation. However, little has been published on actual experience with ethics consultation in paediatrics. The objective of this study was to review and describe topics covered by a large retrospective sample of clinical ethics consultations in paediatric medicine.
Methods:
We reviewed ethics consultations involving patients of <18 years of age from January 2005 to July 2013 at one institution. Descriptive statistics of the patient population, the reason for the ethics consultation and the consultant's perceived contribution to the case were generated. Subgroups of patients were compared based on demographic and clinical characteristics using Wilcoxon's rank sum tests, chi-square tests and logistic regression models.
Results:
Most of the 102 eligible consultations originated from intensive care units and were requested by attending physicians. The most frequent topic leading to consultation was end-of-life issues. Both younger age and male sex were associated with consults for end-of-life issues (p < 0.001 and p = 0.010).
Conclusion:
This analysis provides important information describing the type of consults requested in paediatric medicine, which is necessary given the movement towards professionalising clinical ethics consultation. Further empirical research is needed on ethics consultation in paediatrics.