Five-year experience of clinical ethics consultations in a pediatric teaching hospital

Eur J Pediatr. 2014 May;173(5):629-36. doi: 10.1007/s00431-013-2221-2. Epub 2013 Dec 10.


Our retrospective study presents and evaluates clinical ethics consultations (CECs) in pediatrics as a structure for implementing hospital-wide ethics. We performed a descriptive and statistical analysis of clinical ethics decision making and its implementation in pediatric CECs at Zurich University Children's Hospital. Ninety-five CECs were held over 5 years for 80 patients. The care team reached a consensus treatment recommendation after one session in 75 consultations (89 %) and on 82 of 84 ethical issues (98 %) after two or more sessions (11 repeats). Fifty-seven CECs recommended limited treatment and 23 maximal treatment. Team recommendations were agreed outright by parents and/or patient in 59 of 73 consultations (81 %). Initial dissensus yielded to explanatory discussion or repeat CEC in seven consultations (10 %). In a further seven families (10 %), no solution was found within the CEC framework: five (7 %) required involvement of the child protection service, and in two families, the parents took their child elsewhere. Eventual team-parent/patient consensus was reached in 66 of 73 families (90 %) with documented parental/patient decisions (missing data, n = 11). Patient preference was assessable in ten CECs. Patient autonomy was part of the ethical dilemma in only three CECs. The Zurich clinical ethics structure produced a 98 % intra-team consensus rate in 95 CECs and reduced initial team-parent dissensus from 21 to 10 %. Success depends closely on a standardized CEC protocol and an underlying institutional clinical ethics framework embodying a comprehensive set of transparently articulated values and opinions, with regular evaluation of decisions and their consequences for care teams and families.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Decision Making
  • Ethics Committees
  • Ethics Consultation*
  • Ethics, Clinical*
  • Female
  • Hospitals, Pediatric*
  • Hospitals, Teaching*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Pediatrics / ethics*
  • Quality-Adjusted Life Years
  • Retrospective Studies
  • Switzerland