How to Design, Build, and Pay for a Community-Based Palliative Care Program (P16)

Apply principles of communication theory, mediation, and shared decision making to the process of resolving ethical conflicts in pediatrics. Practice essential skills competencies identified in the Core Competencies of Health Care Ethics Consultation (2nd edition, American Society of Bioethics and Humanities). Clinical ethics consultations in pediatrics are often highly complex and frequently involve evaluations of parental decision-making with particular consideration of the risks andbenefits of alternativemedical pathways. Pediatric providers need to balance their fiduciary responsibility to the patient with respect for autonomy of the family unit. Many ethical dilemmas involve a breakdown in communication rather than a true conflict in core ethical principles. Uncertainty over goals of care, the purpose of a medical intervention, or concern that a child is at risk of harm can be distressing for pediatric providers. Children receiving complex medical technologies or intensive nursing care in the context of a guarded or uncertain prognosis risk triggering provider distress if they fail to improve or clearly benefit from this high level of medical care. The synthesis of ethical principles with high-quality communication and shared decision-making skills may facilitate negotiation of a treatment plan agreeable to clinicians and families and reduce moral distress among clinical staff. This is an important skill for clinicians working with pediatric patients and may resolve conflicts without the need for a formal ethics consultation. As with any form of clinical consultation, documentation of the process and the advice rendered is essential. Formal consultations should be organized into a clinical ethics consult note. For informal consultations, palliative care teams should consider integration of ethical issues into their standard chart note.