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. 2023 Mar 1;151(3):e2022058999.
doi: 10.1542/peds.2022-058999.

Pediatric Ethics Consultation Services, Scope, and Staffing

Meaghann S Weaver  1   2 , Shiven Sharma  3 , Jennifer K Walter  4   3
Affiliations

Pediatric Ethics Consultation Services, Scope, and Staffing

Meaghann S Weaver et al. Pediatrics. .

Abstract

Background and objectives: National standards and guidelines call for a mechanism to address ethical concerns and conflicts in children's hospitals. The roles, responsibilities, and reach of pediatric ethics consultation services (PECS) remain unmeasured. The purpose of this study is to quantify staffing, structure, function, scope, training, and funding of PECS.

Methods: Cross-sectional online survey was shared with an ethics informant at 181 children's hospitals in the United States from March to June 2022. Data were summarized descriptively and with semantic content analyses.

Results: One hundred seventeen surveys were received from individual children's hospitals in 45 states and Washington DC (response rate 65%), with 104 qualifying for survey completion. Almost one-quarter of settings received 50 or more pediatric ethics consults in the past 12 months. On average, 7.4 people at each institution have responsibility for completing ethics consults. Estimated full-time equivalent salary support for ethics is on average 0.5 (range 0-3, median 0.25). One-third (33%) of facilities do not offer any salary support for ethics and three-quarters do not have an institutional budget for the ethics program. Clinical staff primarily initiate consults. End-of-life, benefits versus burdens of treatments, and staff moral distress were the most frequently consulted themes. Almost one-quarter (21%) of children's hospitals do not receive any consults from patients or families.

Conlusions: The findings from this study reveal wide variation in PECS practices and raise concern about the lack of financial support provided for PECS despite substantial workloads.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Dr Weaver participated in this study in a private capacity. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Veterans Affairs, the National Center for Ethics in Healthcare, or the federal government. The other authors have indicated they have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Consult topic frequency.
See this image and copyright information in PMC

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