Pediatric ethics

At Advocate Children's Hospital, we take ethics seriously. The following questions provide answers regarding our approach to ethics.

What are the resources for dealing with ethical problems at Advocate Children's Hospital?

Advocate Children’s Hospital has a Pediatric Ethics Advisory Committee that is available for ethics questions. There is always an ethicist-on-call who can be reached by paging Pediatric Ethics through Perfect Serve at 708-684-1111 or by using the Perfect Serve app.

What is the Pediatric Ethics Advisory Committee?

The Pediatric Ethics Advisory Committee (PEAC) is a multidisciplinary committee that serves both campuses of Advocate Children’s Hospital. It is chaired by Dr. Rupali Gandhi. The committee is comprised of approximately 25 members, including representatives from such departments as:

• Medicine
• Mission and Spiritual Care
• Nursing
• Respiratory therapy
• Social Services
• Surgery

The goal of the PEAC is to provide a forum for education, discussion and guidance regarding ethical decisions. When a consult is requested, members of the committee will help to clarify the ethical problem, explore alternatives, and make recommendations, but the actual decision is left up to the parents (or the patient if he/she is capable of making a decision) and the responsible staff.

Why do we have an ethics committee?

Health care decisions can be quite complex, and people do not always agree about what should be done in a particular case. People do not always have the same values, and it is sometimes necessary to think about which values should determine how to care for a child and family. Advances in medical technology have given us many choices. There is so much that we can do; sometimes we need to pause and talk about what we ought to do. The ethics committee can help navigate some of these situations by applying ethical principles to actual real-world problems.

How do I know when to ask for an ethics consult?

An ethics consult should be considered when a morally troubling or complex problem occurs and the usual ways of handling it do not bring resolution.

Who may ask for an ethics consult?

An ethics consult can be requested by parents, patients or any member of the health care team.

I'm not sure whether I need an ethics consult. Is there someone I can talk to just to figure out if an ethics consult would be appropriate, without necessarily putting the whole process in motion?

Yes, you are welcome to call the on-call ethicist. Please email Rupali Gandhi for an informal discussion about a case or problem. This discussion may or may not lead to a formal ethics consult.

What happens in an ethics consult?

An ethics consult usually involves three members of the PEAC who meet with the staff directly involved in caring for the patient and with the patient and/or the family.

During these meetings, information is gathered and people have an opportunity to discuss the issues that are troubling them, as well as their reasons for favoring one course of action or another. Then the PEAC consult team meets privately to discuss the issues, refine the ethical analysis and write a report that includes their advice and recommendations.

The consult note is placed in the patient’s medical record and a copy is provided to the patient and/or parents. In addition, members of the consult team will usually discuss their written report with the team members and the patient/family.

In a few cases an ethics consultation may be discussed with the whole ethics committee because:

1. The caregiver or patient/parent(s) request the deliberation and advice of the full committee.
2. The ethical question is considered by the ethicist to be particularly difficult or novel.
3. The ethics consult team’s deliberations about a case left them in doubt or disagreement about what to advise the staff and family.

Occasionally the medical team requests comments regarding policy or practice that do not involve our meeting with patients and families, and the above process will be abridged accordingly.

Is it necessary to inform the patient and/or the family of an ethics consult requested by staff?

Yes. The patient and family are considered an integral part of the process of ethics consultation. We will inform the patient and/or family of the consultation if the consult is requested anonymously.

What information is documented in the medical record?

The PEAC consult team writes a report, including a list of who was present for each discussion, along with a summary of the pertinent issues and recommendations. The PEAC consult report becomes part of the patient’s medical record. Copies of the report are given to the parents and staff who were involved in the ethics consultation. Staff members may also record the consult meeting(s) in their progress notes.

What happens after an ethics consult?

A member of the ethics consult team will discuss the team’s advice with staff and family. Ultimate responsibility for decisions about the patient's care, including ethical decisions, remains with the care team and family. Parents and staff are not required to follow the recommendations of the Pediatric Ethics Advisory Committee.