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Making difficult medical decisions

Pediatrics Ethics Committee available to help

pediatric ethics committeeWhen someone is ill, they typically seek medical care. Usually simple enough, but there are those complex situations where medical care also involves making decisions about ethics.

I first became interested in medical ethics during my pre-med undergraduate studies. I took an ethics course and thought it was the most important part of being a doctor. That drove me to pursue additional education in medical ethics as well as my training as a pediatric plastic surgeon.

The Pediatrics Ethics Committee at C.S. Mott Children’s Hospital is comprised of representatives from different areas of the hospital as well as members of the community. We meet to discuss cases and review policy, but are also available 24/7 when someone requests an ethics consult. We often facilitate family meetings when there are differences of opinion on the best approach to take on a patient’s care. Ethics consults can be requested by anyone on the care team, patients or family members.

During an ethics consult, we bring academic discipline to what are typically emotionally charged conversations. We listen to all perspectives, facilitate communication and present options for consideration. We don’t provide one answer to a situation—there is often no one right answer. We educate everyone involved about the guiding ethical principles involved and help to clarify issues. The Committee includes members who are skilled at conflict resolution and we bring those skills to a situation when needed.

Some of the type of questions brought to the committee include:

  • Is it OK to keep this patient on the ventilator even if they have no chance of meaningful recovery?
  • Can minors refuse an operation or medical treatment?
  • Is it OK to stop a medical treatment? Is that the same as killing?
  • Do I have to tell my child about their genetic diagnosis?
  • My religious beliefs prohibit certain medical interventions? Can I refuse them for my child?
  • Is it ever OK to sterilize a child?
  • Parents and doctors all disagree about treatment in the ICU.

The Pediatric Ethics Committee also weighs in on policies such as healthcare professionals treating family members and the provision of charity care. We make sure that all angles are being taken into account when any policies are created or being evaluated.

Another key role of the committee is education. We conduct bioethics grand rounds once a month that are open to anyone. These hour-long lectures cover a wide range of topics throughout the year and are run in conjunction with the adult ethics committee.

After challenging situations, we conduct debriefing sessions for all the healthcare providers involved. These allow us to discuss the patient’s care, the ethical considerations in play and the course of action. It’s a good opportunity for everyone’s voice to be heard and share perspectives. These sessions also help us prepare for similar situations that occur in the future.

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christian vercler mdChristian J. Vercler, M.D., is the co-chair of the Pediatric Ethics Committee at C.S. Mott Children’s Hospital.  He is a practicing pediatric craniofacial surgeon and serves as a Clinical Assistant Professor in the Division of Craniofacial Surgery in the Section of Plastic and Reconstructive Surgery at the University of Michigan. He has a special interest in medical ethics, and also serves as Faculty of the Center for Bioethics and Social Sciences at the University of Michigan. He completed a Fellowship in Clinical Ethics at the Emory University Center for Ethics and earned a Masters of Arts degree in Bioethics from Trinity. He has served on ethics committees and has taught medical ethics to residents and medical students at Emory University, Harvard, and the University of Michigan.

best children's hospitalsUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.