Objectives: To identify the nature and frequency of ethical challenges experienced by employees at a pediatric postacute care (PPAC) hospital, and to inform institutional efforts to better meet the needs of employees facing ethical challenges and improve patient care.
Study design: We surveyed health care providers at a PPAC hospital in the United States to investigate the ethical challenges they face. The anonymous, mixed-methods survey instrument included 8 multiple choice and free response questions covering the following: demographic information, frequency of encountering 33 potentially ethically-challenging issues, description of 2-3 challenging ethical scenarios, and an assessment of available institutional ethics resources.
Results: One hundred four individuals completed the survey (response rate: 30%). The most commonly encountered ethical issues in the PPAC setting included discharge disposition (41%), inter-team (33%) and team-parent communication issues (27%), behavior problems (28%), and goals of care (24%). Further, many (54%) employees did not feel they have appropriate institutional resources to navigate ethical dilemmas, with the development of an institutional ethics committee as the most identified needed resource.
Conclusions: The most commonly encountered ethical issues in PPAC settings relate to discharge, communication, behavior, and goals of care and these challenges may be due to the unique nature of PPAC institutions. Several ethically challenging issues arising in the PPAC setting, like admissions and discharge decisions, are underexplored in the pediatric ethics literature and deserve additional research and attention. PPAC employees would likely benefit from additional resources, like the development of an institutional ethics committee to provide education and consultation.
Keywords: ethical issues; pediatric postacute care.
© 2025 The Authors.