By Brianne Helfrich

Pediatric healthcare is different — parental involvement in decision-making, the heightened pressure to “save a child”, and the emerging voices of pediatric patients make this field uniquely challenging. From an ethics perspective, these cases can be complex and emotionally charged. Clinicians often delicately balance the wishes of the families, patients and organizational policies — often under significant pressure.

Typically, hospitals have a centralized bioethics department with a hospital-wide ethics framework. This framework serves to guide ethicists in finding ethically supportable solutions for the various cases they encounter. But we ought to acknowledge that not all departments, patients or ethicists are the same. So, does a single hospital-wide framework or centralized bioethics department truly benefit patients, families and clinicians?

Consider two cases:

Patient A is admitted to the cardiology department. This teenage patient is verbalizing his desire to pursue intensive treatment, yet his family is fearful of the risks involved. Therefore, they refuse to provide their consent to treatment, contradicting their son’s wishes.

Patient B is admitted to the urology department. This patient’s family lacks understanding and comprehension of the diagnosis. Therefore, the family is unable to make informed decisions in alignment with the best interests of their child.

Both situations involve general ethics principles — pediatric assent and informed consent. Yet, the clinical contexts differ. Patient A’s situation involves high-risk and life-altering interventions, where patient voice and parental consent are at a crossroads. In comparison, Patient B’s situation requires addressing comprehension and communication barriers.

This illustrates the potential value of department-specific ethicists. An ethicist embedded within the cardiology department may better navigate the complex risk-benefit discussions with the family. In contrast, one embedded within urology may have strategies and tools to explain the diagnosis better and create more transparent communication. Extending this logic to other departments (NICU, PICU, Surgery, Psychiatry, etc.) could lead to quicker, more nuanced consults and resolutions. The ethicist can ensure the ethical considerations match the clinical realities of the specialty.

Another critical benefit lies in trust-building. Clinicians or families may hesitate to request consults due to fear of judgment or delay. However, embedding an ethicist within the department provides the opportunity for relationships to build organically. It allows clinicians and families to view ethicists as collaborative partners and part of the care team, rather than external authorities. This relational trust may encourage ethics involvement to be sought out early, before conflicts escalate.

Department-specific ethicists may create a continuous learning environment within the hospital. When ethicists are embedded in various departments, they can bring key insights to the centralized ethics framework. Rather than a static framework, the hospitals may implement a living framework that evolves with the lived experiences of each ethicist and specialty. Department-specific ethicists can help to ensure the hospital’s policies are rooted in practice, rather than just theory.

The field of pediatric medicine is evolving — new technological discoveries (AI), increasing recognition of the value of pediatric input in decision making and the ongoing physician shortages. The field of ethics must adapt and evolve alongside it. Implementing a department-specific ethics model is not meant to discredit the current ethical frameworks in place. Rather, it can be a method to increase clinician trust and efficacy, encourage consistent learning and further hospital-wide policy development. Clinicians choose a specialty, so why don’t ethicists?

Conflicts of Interest: None declared