The Department of Medical Ethics, and.
Pediatrics. 2014 Feb;133 Suppl 1:S1-7. doi: 10.1542/peds.2013-3608B.
The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. At the same time, the personal and professional relationships between PPC and PME present challenges, including potential conflict with colleagues, perceived or actual bias toward a palliative care perspective in resolving ethical problems, potential delay or underuse of PME services, and a potential undervaluing of the medical expertise required for PPC consultation. We recommend that these challenges be managed by: (1) clearly defining and communicating clinical roles of PPC and PME staff, (2) developing questions that may prompt PPC and PME teams to request consultation from the other service, (3) developing explicit recusal criteria for PPC providers who also provide PME consultation, (4) ensuring that PPC and PME services remain organizationally distinct, and (5) developing well-defined and broad scopes of practice. Overall, the rich relationship between PPC and PME offers substantial opportunities to better serve patients and families facing difficult decisions.
儿科舒缓治疗（PPC）和儿科医学伦理学（PME）领域由于各种历史、文化和社会因素而有很大的重叠。这种交织的关系为两组提供者提供了利用彼此强大的沟通技巧的机会，以及资源共享和研究合作的潜力。与此同时，PPC 和 PME 之间的个人和职业关系也带来了挑战，包括与同事潜在的冲突、在解决伦理问题时对舒缓治疗观点的感知或实际偏见、潜在的 PME 服务延迟或未充分利用，以及对 PPC 咨询所需的医学专业知识的潜在低估。我们建议通过以下方法来管理这些挑战：（1）明确界定和沟通 PPC 和 PME 工作人员的临床角色；（2）提出可能促使 PPC 和 PME 团队向另一项服务请求咨询的问题；（3）为同时提供 PME 咨询的 PPC 提供者制定明确的回避标准；（4）确保 PPC 和 PME 服务在组织上保持独立；（5）制定明确和广泛的实践范围。总体而言，PPC 和 PME 之间丰富的关系为更好地为面临艰难决策的患者和家庭提供服务提供了巨大的机会。
