Supplements

Ethics

Copyright © 2010 Society of Hospital Medicine

Introduction

Morality is the right or wrong of human conduct, where ethics is the disciplined study of the justification for rules of human conduct. Morality concerns obligations of what ought to be and what virtues should be cultivated to sustain a truly moral society. The field of bioethics (or medical ethics) applies theory to address ethical issues in medicine, including those that arise during the care of patients as well as those focused on organizations and policy. Bioethics focuses on what morality should be for patients, healthcare professionals, healthcare institutions, and healthcare policy. The rights and responsibilities of patients and the fiduciary responsibility of healthcare providers to patients are central to this definition. Pediatric hospitalists must have a basic knowledge of ethical principles to provide balanced, ethical care.

Knowledge

Pediatric hospitalists should be able to:

  • Describe the core principles of ethics: beneficence, justice, respect for autonomy, and non‐maleficence.

  • Discuss the four virtues of a fiduciary‐ self‐effacement, self‐sacrifice, compassion, and integrity.

  • Identify the elements of informed consent and describe the concept of informed assent.

  • Describe special circumstances impacting the informed consent process specific to the pediatric population, such as patients in the juvenile justice system, ward of the court, emancipated minors, child protection cases, and others.

  • Describe the role and composition of the hospital Ethics Committee.

  • Compare and contrast the fiduciary responsibilities of the institution, insurer, and healthcare provider and discuss the impact of these on delivery of ethical patient care.

  • Distinguish between substantive justice (concern that the outcomes of a process is fair) and procedural justice (concern that the decision‐making process itself is fair).

  • Describe how ethical principles can inform development of healthcare policy.

  • Give examples of how patients and the family/caregiver meet ethical obligations to healthcare professionals (such as engagement in informed consent), to others in the household (such as discussions on undue burden to other members), and society (such as appropriate allocation of resources).

  • Explain the concept of medical futility and its shortcomings.

Skills

Pediatric hospitalists should be able to:

  • Apply ethical principles to daily patient care.

  • Obtain informed consent and assent, as appropriate.

  • Access legal support as needed to obtain consent to treat as appropriate in special circumstances.

  • Communicate effectively, maintaining confidentiality and patient privacy.

  • Identify situations involving ethical conflict, and take steps to resolve this conflict.

  • Consult the Ethics Committee/Team appropriately.

Attitudes

Pediatric hospitalists should be able to:

  • Acknowledge personal biases that impact ethical decision‐making.

  • Recognize gaps in knowledge and seek opportunities for ethics education.

  • Role model ethical practices.

Systems Organization and Improvement

In order to improve efficiency and quality in their organizations, pediatric hospitalists should:

  • Work with hospital administration to identify and modify institutional practices and policies to assure ethical healthcare delivery.

  • Advocate for healthcare policy that ensures appropriate access to healthcare services for children.

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