Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Department of Pediatrics, Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatrics. 2021 Apr;147(4). doi: 10.1542/peds.2020-1087. Epub 2021 Mar 5.
Pediatric ethics consultations are important but understudied, with little known about consultations' contextual attributes, which may influence how ethically problematic situations are perceived and addressed.
We analyzed data regarding 245 pediatric clinical ethics consultations performed between 2013 and 2018 at a large children's hospital. Prespecified data elements included 17 core problematic issues that initiate consultations, 9 ethical considerations identified by the consultation service, and 7 relational, emotional, and pragmatic contextual attributes of the consultation. The main process measure was the cumulative consultation process, ranging from one-on-one discussions with the requestor, to meeting with the clinical team, separate meetings with the patient or family and the clinical team, or combined meeting with the patient or family and the clinical team.
The most-prevalent core problematic issues were intensity or limitation of treatment (38.8%) and treatment adherence and refusal (31%). Common pertinent ethical considerations were best interest (79.2%), benefits versus harms of treatment (51%), and autonomy and decision-making (46.5%). A total of 39.2% of consults culminated with a meeting with the clinical team, 9.4% with separate meetings, and 8.2% with a meeting with all parties. Common contextual attributes were discord (43.3%), acknowledged dilemma (33.5%), and articulate disagreement (29.8%). In exploratory analyses, specific contextual attributes were associated with the core problematic issue that initiated the consultation and with how the consultative process culminated.
Pediatric ethics consultations have contextual attributes that in exploratory analyses are associated with specific types of problems and, to a lesser degree, with the cumulative ethics consultation process.
儿科伦理学咨询很重要，但研究不足，对于咨询的背景属性知之甚少，而这些属性可能会影响人们对伦理问题的看法和处理方式。
我们分析了 2013 年至 2018 年期间在一家大型儿童医院进行的 245 例儿科临床伦理咨询的数据。预设的数据要素包括 17 个引发咨询的核心问题、咨询服务确定的 9 个伦理考虑因素以及咨询的 7 个关系、情感和实际背景属性。主要过程衡量标准是咨询的累积过程，从与请求者的一对一讨论，到与临床团队会面，再到与患者或家属以及临床团队分别会面，或与患者或家属以及临床团队联合会面。
最常见的核心问题是治疗的强度或限制（38.8%）以及治疗的依从性和拒绝（31%）。常见的相关伦理考虑因素是最佳利益（79.2%）、治疗的益处与危害（51%）和自主权与决策（46.5%）。总共 39.2%的咨询以与临床团队会面结束，9.4%的咨询分别与患者或家属以及临床团队会面结束，8.2%的咨询与所有各方会面结束。常见的背景属性是意见不一致（43.3%）、公认的困境（33.5%）和明确的分歧（29.8%）。在探索性分析中，特定的背景属性与发起咨询的核心问题以及咨询的累积过程有关。
儿科伦理学咨询有背景属性，在探索性分析中与特定类型的问题以及咨询的累积过程有关。
