Comparing Models for Clinical Ethics Consultation: Which Approach is Best for Pediatrics?

Abstract: Resolving ethical challenges in pediatrics is difficult. No standard approach to clinical ethics consultation exists, and significant variability arises within and between institutions. Multiple models for ethical analysis have been proposed, each with specific strengths and weaknesses, particularly in the pediatric context.

In this interactive workshop, participants will collaboratively explore, apply, and test four models of ethics consultation:

The “four box” approach proposed by Jonsen-Siegler-Winslade (which separates areas of analysis into four domains: medical indications, patient preferences, quality of life, and contextual features)
The Orr-Shelton method (which outlines a formal process for completing and documenting ethics consultation in a manner mirroring many other clinical consultation models in medicine)
The Zurich model (which offers a 7-step protocol intended to facilitate moral inquiry, deliberation, and consensus through effective communication, mediation, implementation of the plan, and appropriate follow-up)
The QUAR framework introduced by the Children's Mercy Bioethics Center (which identifies a four-step process for completing an ethics consultation: Question, Understand, Assess, Recommend)

Following a brief didactic session introducing each model and describing its strengths and weaknesses for pediatric ethics, breakout groups led by ethicist facilitators will analyze a complex pediatric ethics case to gain further experience with practical application of these models. Finally, the groups will reconvene to compare their findings, discuss implications, and identify how elements of each model may have benefit in specific cases and circumstances. Participants will also be provided with handouts summarizing the key points from each method of ethical analysis.

Keywords: Pediatric Ethics, Ethics Consultation