Publication
Who You Gonna Call? Ethical Conundrums in Pediatric End-of-Life Care
Macauley R, Carter B, Collura C · Journal of Pain & Symptom Management · 2025
Pediatric end-of-life cases require a nuanced response to complex challenges (e.g., limits of parental authority, duty of child protection, and the inherent ambiguity–even impracticality–of the best interest standard). This is especially the case in the neonatal context, where uncertain prognoses, institutional culture, and relevant state law also play a role.(1) While pediatric palliative care (PPC) providers often have greater facility in these areas than their pediatric subspecialty colleagues, a relative paucity of formal ethics training exists in most palliative care fellowship programs.(2) This may prompt the PPC team to seek formal ethical consultation in the most challenging of cases.(3) While a risk of role confusion exists,(4) ethicists can bring greater impartiality and analytic expertise, allowing palliative care clinicians to focus on empathetic communication and support of the patient and family.(5) Pediatric cases, however, comprise only a small fraction of ethics consultations. As such, clinical ethicists may not be prepared for the degree of complexity that would drive a PPC team to seek assistance. So, who is best equipped to respond: an ethicist without significant pediatric experience, or a pediatric palliative care clinician without formal ethics training? This panel presentation of three PPC specialists (including two neonatologists) with formal training in ethics consultation will begin by comparing the myths of ethics expertise among palliative care clinicians with the reality of how much ethics training these clinicians typically receive. Then we will examine pediatric subspecialty areas that clinical ethicists may not be equipped to navigate (e.g., genetic, maternal-fetal, neonatal), providing resources to gain greater ethical proficiency. Finally, we will explore the risks and benefits of dual consultation, drawing on each discipline's respective strengths.
Synced from the TRENDS in Pediatric Palliative Care Zotero library, curated by The Siden Research Team. ICPCN does not host or verify the full text.