A case of conflict in pediatric end-of-life decision making is presented to compare the complementary roles of clinical ethics consultants and palliative care specialists. The progression of the case illustrates the differing structures, goals, and methods of the majority of such teams. The strengths of each of consultation are emphasized. Particularly in centers where palliative care services are not available, it can be important for careproviders and clinical ethics consultants to focus on alliance-building and a longitudinal relationship with patients and (...) families. (shrink)
Identifying ethically allowable options for infants with trisomy 18 has become more challenging as medical standards of practice shift, based on emerging scientific data and changing societal perceptions of disability. Lack of a stable professional standard of practice ought not prevent ethicists from facilitating a consensus; rather, these “unsettled cases” require an individualized, narrative approach that allows the values of the family and the particularities of each case to provide the necessary additional moral grounding.