A Historical Perspective on Pediatric Ethics Consultations

In 1984, following the 1982 Baby Doe case, the American Academy of Pediatrics recommended the formation of “infant bioethics committees” at children’s hospitals nationwide.
Paper minutes of committee meetings from 1984-1998 at a tertiary care children’s hospital were reviewed for content. Data was extracted from the minutes including year of consult, age and sex of patient, reason for consult request, ethical issues identified, and result of meeting.
There were 79 consults recorded, ranging from 1-12 per year (0 in 1984). The median age of patients involved in consults was 0.33 years (IQR 0.07-1.5 years). Overall, 67 consults (85%) involved some limitation of life-sustaining treatments. Of the remaining 12 consults, 10 involved requests for termination of pregnancy. The term “best interest” first appears in 1988; 42% of consults reference best interests. The first evidence of moral distress on the part of the care team appears in 1991; 5% of consults reference care team distress. In 15 consults (19%) there was evidence of disagreement between the family and the care team.
In this early era, the majority of consults involved limitation of life-sustaining treatments or termination of pregnancy. There was evidence of disagreement between the families and care teams in fewer than one in five cases; rather, cases appeared to be brought before the committee for approval of a plan already agreed upon. We speculate that this pattern is reflective of the political/legal climate at the time, with fear of repercussions for decisions to limit life-sustaining treatments.

Richard Schreiner – Pediatrics – Indiana University; Zeynep Salih – Pediatrics – Indiana University