By Stacey Kusterbeck
When consulting on pediatric cases in the outpatient setting, ethicists see distinct issues compared to the inpatient setting, a recent study found.1 “Little has been reported about pediatric ethics consults in general, and about outpatient ethics consults specifically,” says Janice Firn, PhD, MSW, HEC-C, one of the study authors and a clinical ethicist at Michigan Medicine and Center for Bioethics and Social Sciences in Medicine.
Firn and colleagues reviewed all 48 outpatient ethics consults over a six-year timeframe at a large academic medical center. Some key findings included:
- The most common primary ethical issues were best interest concern and beneficence, refusal of recommended treatment, and patient preference.
- The most common contextual features were communication disputes between the staff and family, legal involvement, and quality of life.
- Hematology/oncology was the most common consulting specialty.
“One finding that we are interested in exploring further in future work is that, although general pediatrics cares for about half of pediatric patients, they accounted for only one consult,” says Firn. It is possible that ethics consults are not being used in this context because they are not needed, since pediatricians have a high level of competency in resolving ethical issues without outside assistance. On the other hand, barriers to accessing ethics consultations could exist in general pediatric settings. “Further research is needed to understand what, if any, barriers exist. Clinics, especially those not physically connected to the hospital building, may not be aware that they have access to ethics consultation,” suggests Firn.
In some care settings, guidelines outlined criteria for ethics consultation and ethicists were involved in developing policies. “This organizational ethics emphasis and involvement is potentially one key difference between the ambulatory and inpatient settings,” says Firn.
To increase access and use, ethicists could consider embedding ethics consultation into policies in outpatient settings. For example, ethicists can be key stakeholders in policy development on how outpatient clinics will manage vaccine refusal. “As a stakeholder, ethicists are then part of the review cycle for the policy going forward,” says Firn.
Reference
- Freigeh GE, Fagen H, Firn J. Review of outpatient pediatric ethics consults at an academic medical center. HEC Forum. 2024;Aug 22. doi: 10.1007/s10730-024-09536-3. [Online ahead of print].
