Welcome to the Office of Ethics | Overview
The Office of Ethics provides ethics support for clinicians, patients, and families when ethical issues arise in caring for patients (inpatient and outpatient) at Boston Children's Hospital. An ethical issue may arise when there is disagreement as to what the right (or acceptable) thing to do is between or amongst clinicians, parents, families, or other decision-makers and/or the patient. The source of the disagreement may be due to differing goals of care or differences in values, culture, religious, spiritual, or personal beliefs. Disagreements or uncertainty as to what ought to be done can be distressing for patients, parents (or other decision-makers), families, and clinicians.
The Office of Ethics is staffed by clinical ethicists and ethics associates — hospital clinicians with advanced training in medical ethics — who are available to provide ethics support and consultation to families and clinicians facing an ethical dilemma or who have ethical concerns. A patient, parent (or other family member or decision-maker), or any health care professional involved in the care of a patient may request ethics support at no charge. A clinical ethicist is available 24 hours per day. During business hours, an ethicist can be reached in the office at 617-355-6920, or by paging the on-call ethicist at #3418. On weeknights, holidays, and weekends, call the page operator and request the ethicist on call at #3418.
Ethics support and consultation services
The Office of Ethics provides both ethics support as well as more formal consultations upon request. When you call or page the Office of Ethics, an ethicist will speak with you to learn more about the nature of the conflict or dilemma and your concerns. Sometimes, the conflict or dilemma can be resolved or a path forward identified through conversation with the ethicist who may provide the caller and/or other involved parties with ethical principles that apply in the particular circumstances. The ethicist may also gather additional information and attend a meeting with clinicians to explore the ethical implications of the treatment options that are being offered and/or recommended. If an acceptable path forward cannot be agreed upon, an ethics consultation can be requested by parents (or other decision-makers), family members, the patient, or any health care provider. If such a request is made, a small ethics consultation team (2-4 individuals) meets with those involved (parents, clinicians, and the patient if appropriate) and then makes recommendations regarding ethically acceptable courses of action. The recommendations are shared with stakeholders. Under certain circumstances, a larger ethics consultation team may be responsible for the consultation. Ethics consultations and recommendations are advisory only, and final decision-making remains with the patient, parents (or other decision-makers), and the health care team.
Frequently asked questions
What are examples of ethical dilemmas that the Office of Ethics can help with?
- You and your doctor disagree about what should be done for your child.
- You and your child disagree about the treatment being offered or recommended.
- The treatment being recommended conflicts with your personal, religious, or spiritual beliefs.
- Your child is over 18 years old and you are concerned about his or her ability to make decisions.
- Your child is over 18 years old and is making decisions that you disagree with.
- You are concerned that your child is being treated differently than others with respect to the care being offered or provided.
- You are uncertain about how much medical and/or prognostic information should be shared with your child.
What should I do if I'm not certain if there is an ethical dilemma?
If you suspect that you have an ethical issue or dilemma and are in need of assistance, the ethicist on call can help in determining whether the Office of Ethics can assist in thinking through or resolving the issue that you are facing. To the extent that the issue is not an ethical dilemma, the ethicist may be able to provide guidance as to who you might speak with for support.
What are the advantages of consulting the Office of Ethics?
Though it can be difficult to bring an outsider's input into a complex case, sometimes a more objective viewpoint helps to clarify the issues and increase communication among the involved parties. The ethical implications of various alternatives are explored, which can be informative and validating to those facing morally distressing choices. Since staff clinical ethicists and EAC members have continuing education in biomedical ethics and are familiar with the kinds of cases that raise ethical issues, they can be efficient and effective at exploring medically and morally complex cases and offering ideas for dealing with them.
The creation of an Ethics Advisory Committee reflects awareness of the heightened concern surrounding decision-making for the critically ill child, specifically in the initiation, withholding and withdrawing of treatment. In May 1983, at the recommendation of the President and Board of Trustees, an ad hoc Committee to Review Issues Related to the Care of Critically Ill Patients was established, which reviewed and reported on the various medical, ethical, and legal considerations which affect these treatment decisions. The Committee recommended and the Board of Trustees voted to establish a Hospital Ethics Advisory Committee as a standing committee of the Medical Staff, reporting directly to the Steering Committee and President of the Hospital.
The Committee serves as a forum for education, discussion, and guidance to develop a broadly-based foundation in the Hospital community upon which ethical decisions may be made that will be consistent with the provision of optimal patient care. Specific functions of the Committee are the following:
- Designing and implementing an educational program in the ethics of health care, to be available to all members of the Hospital community.
- Recommending policies and procedures for generic medical/ethical situations, e.g., documentation of decisions to withdraw specific treatment.
- Being available to provide consultative assistance to physicians, nurses, parents, and appropriate others when uncertainty or practical disagreement concerning medical/ethical patient care decisions arise.
- Reviewing and studying the overall experience of parents, patients, and staff, and making recommendations about how best to be fully responsive to their needs in the area of medical/ethical decision-making.
- Retrospective review of medical records in selected cases where life-sustaining treatment has been foregone and in other medical/ethical situations as the Committee shall determine. The review shall include evaluation of compliance with applicable hospital policies as well as the appropriateness of such policies.
The President shall appoint the Chairperson. Members shall be appointed jointly by the President and the Steering Committee. Appointments shall be for three-year periods.
The Committee shall be multidisciplinary and shall consist of twenty members and two co-chairs, with representatives from Medical Staff, Nursing, Social Services, Administration, Parents, and Clergy. In addition, the Committee may request the advice or assistance of such consultants as it determines necessary.
The Committee shall meet regularly and report periodically to the Steering Committee and the President. The Committee shall arrange for 24-hour emergency availability.
Approved by the Steering Committee: October 9, 1984
© 1998-1999 Ethics Advisory Committee
Updated August 2, 1999