Ethics Program

The Children’s National Hospital (CNH) Clinical Pediatric Ethics Program offers education and support/consult services to faculty, staff and patients throughout the CNH network. Our team helps parents, patients and providers navigate ethical concerns and dilemmas that can present in all aspects of patient care. In addition to the clinical ethics consultation service, the Ethics Program is home to the Clinical Ethics Committee.

Education

The Ethics Program also educates clinicians, staff and trainees on clinical ethics through various educational forums. These include unit-based ethics rounds, division/department lectures, graduate medical education speaking series, and employee onboarding/orientation programs.

Additionally, the annual Leikin Lectureship and Ethics Day, which is a full day of ethics education open to all members of CNH is held during the month of May.

Consultation

Ethics consultation is available to provide support to all CNH colleagues, patients, family members/loved ones and decision makers who are facing a values conflict in patient care decisions. This service is available free of charge and 24 hours per day. Ethics consults aim to facilitate complex decision making for hospital staff, patients and families by helping to explore ethical decision-making frameworks intended to identify and analyze organizing ethical principles and bioethical best practices. Central to this process is creating an open and collaborative space in which those involved in a patient’s care are enabled to share their perspectives and values related to the patient’s care in a nonjudgmental forum. These conversations are part of a process intended to identify a range of ethically appropriate options to be considered in the patients plan of care. We work together with staff and families using established principles within the bioethics tradition and best practices supported by research.

Clinical Ethics Committee

The Ethics Program has a Pediatric Clinical Ethics Committee (CEC) consisting of both Children’s National employees and community members with a background in ethics. This committee meets monthly to review selected cases and questions brought to the consult service and engage in educational programming related to current issues in pediatric ethics and consultation. The committee occasionally advises on relevant policy and practice revision.

Members of this committee include ethicists, physicians and nurses from multiple specialties, social workers, chaplains, parent navigator, attorney, child life specialist, psychologist and community members with a background in ethics. This committee meets once a month to review recent cases, further their ethics education.

What are some clinical ethics issues?

The consultation service and clinical ethics committee are often involved in cases involving the following issues/questions:

Informed consent
End of life decision making including the withdrawal and withholding of life-sustaining treatments
Withholding information from children and disclosure
Children’s participation in decision making/assent
Moral distress
Culturally sensitive care
Complex discharge planning
Prenatal screening/diagnosis and genetic testing
Children’s participation in clinical research
Vaccination practice/hesitancy
Communication and confidentiality practices
Participation in clinical research

How can I request an ethics consult?

You may contact the clinical ethics consultation service by email or pager at 202-259-2082.

Frequently Asked Questions

How do I know if my concern or dilemma is appropriate for an ethics consult?

The ethics consult service welcomes any and all questions or concerns. A member of the team is always available to talk through how we can be helpful or how another resource may be more useful for you.

Some examples of requests for ethics consults are:

When a recommended treatment goes against a family’s cultural or religious beliefs
When the family or the care team wants to stop treatment on a child for concerns of futility
When a provider is having moral distress about a particular case or policy
When a family or care team disagree about treatment for a child

What happens after I email or page the ethics committee?

Once you reach out to us, a member of the committee will reach back out to you by email or phone. After this initial conversation, if you and the committee member agree that an ethics consultation would be helpful, we will work with you and the other relevant team members involved to arrange a meeting.

You may choose to anonymously request a conversation or consult, in which case you would not be identified as the person requesting the consult.

What happens in an ethics case conference or consultation?

In an ethics case conference, one to three members of the Clinical Ethics Committee meet with members of the patient’s health care team. The ethics team leader will set up a date, time and place and contact those who need to be involved. If the parents are also involved in the meeting, we refer to this as an ethics consultation. Most patients are represented by a parent or guardian, although patients 18 years and older are automatically included. Families are encouraged to bring a support person — a relative, close friend, pastor or anyone they trust.

Together, the group thinks through what is best for the care of the individual child, in the individual situation. We respect the dignity of all and ensure that:

Every person is heard;
Family values are clarified; and
The goals of care are discussed.

The goal is to arrive at an answer to the question, “What are the best choices we have in the care of this child?”

Ethics conversations, case conferences and consultations are often brought back to the monthly CEC meeting for discussion and further recommendations. Formal documentation of ethics consultations are made in the patients chart with recommendations by the consultants and committee.