The Slow, Steady Development of Pediatric Ethics Committees, 1975-2013

Abstract

1. Doug Myers, MD* 2. John Lantos, MD† 1. *Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant, Children’s Mercy Hospitals and Clinics, Kansas City, MO. 2. †Children’s Mercy Bioethics Center and Department of Pediatrics, University of Missouri-Kansas, Kansas City, MO. * Abbreviations: ICRC: : infant care review committee IEC: : institutional ethics committee During the last 30 years, most children’s hospitals in the United States have created pediatric ethics committees or other formal methods to address the ethical issues that arise in the clinical practice of tertiary care pediatrics. Ethics committees or consultants are called on to advise physicians, nurses, other health care professionals, and parents in cases that raise controversial ethical issues. They take many forms and use many different processes to identify and resolve ethical dilemmas. Such committees have themselves been somewhat controversial. On the surface, they seem to be well accepted. They are endorsed by the American Academy of Pediatrics, (1) by the Joint Commission, (2) and in many legal decisions. (3) Although well accepted by many physicians and nurses, ethics committees are only consulted approximately once a month or less in most children’s hospitals. (4) In this article, we review the history of pediatric ethics committees, discuss their roles, and examine some critiques of ethics committees. We then discuss attempts to define the process of ethics consultation and measure the quality of such consultations. We conclude with a tentative agenda for future research on the efficacy of pediatric ethics committees. The idea of hospital ethics committees was first proposed by a pediatrician. In 1975, Dr Karen Teel, a Texas pediatrician, published a short article in the Baylor Law Review . (5) She chose to publish in a law journal rather than a medical journal, suggesting that the climate at the time within medicine was not receptive to the idea of committees to review the ethics of clinical decisions. Clinical-ethical issues were seen more as dilemmas for the legal …