Developing guidance for communication with families in pediatric ethics consultation

Luke Mosley, MD MTS – Pediatrics, Bioethics and Humanities – University of Washington School of Medicine; Vanessa Madrigal, MD – Pediatrics – George Washington University School of Medicine; Arika Patneaude, MSW, LICSW, APHSW-C – Bioethics and Palliative Care – Seattle Children's Hospital; Jennifer Kett, MD MA – Pediatrics, Bioethics and Humanities – University of Washington School of Medicine

Abstract: Notifying and speaking to the adult patient or their surrogate is an accepted norm in clinical ethics consultation and a requirement for direct communication with the patient or surrogate is included in the ASBH Core Competencies. Yet in pediatric ethics consultation, practices of notification and communication with surrogates vary with consultation often directed at supporting the medical team and notifying and speaking with surrogates occurring at the discretion of the consultant or the primary medical team. This raises concerns of equity and fairness and highlights a need to develop clear guidance for communication in pediatric ethics consultation. This paper discusses such efforts at two quaternary children’s hospital to develop policies and standardize and improve surrogate notification and communication through quality improvement.
The authors will review guidance from ASBH Core Competencies and AAP Committee on Bioethics regarding communication with families in pediatric ethics consultation along with the published literature on communication practices in pediatric ethics consultation. Next the authors will analyze proffered justifications for and against routinely speaking to surrogates during pediatric ethics consultation and consider possible differences between pediatric and adult consultation along with particular types of ethics consultations including when the conflict is between members of the medical team, staff moral distress, and cases where the patient and family’s values are previously well defined or the medical team requests the ethics consultant not communicate directly with the family. Finally, the authors will present efforts developed at two quaternary children’s hospitals to standardize and improve family communication through quality improvement.

Keywords: communication, Notification, pediatric ethics consultation