The Ritchie Centre Seminar Committee was pleased to host Dr Sarah te Pas, a paediatric intensivist from the Sophia Children’s hospital at Erasmus Medical Centre, Rotterdam, in the Netherlands, speaking about ethics and moral distress in the Paediatric Intensive Care Unit (PICU). By her own admission, Sarah is not an ethicist but has an interest in the ethics of care related to her work and has completed a master’s degree in the “Ethics of Care”. Sarah provided the audience with some theoretical background on ethics, ethics in science and ethics in medical care referring to the four cardinal virtues of ethics included prudence, justice, temperance and courage and the pillars of the Hippocratic Oath including autonomy, beneficence, non-maleficence and justice. When the concept of justice is involved in the ethics of care it becomes complicated as equal distribution of health care services and the costs involved become issues.
Sarah also discussed moral distress,
which occurs when a person knows what the right thing to do is but is unable to
do it due to some constraint. This is in
contrast to ethical dilemma’s, where a person is grappling with what is right
and what is wrong. The most common cause
of moral distress in the PICU is when parents and doctors disagree on
treatment. For example, the treating
physicians may believe that treatment will result in an unacceptable residual
morbidity and impairment of quality of life and therefore that treatment should
be withdrawn and the patient palliated.
However, as it is the decision of the parents, if the parents want
treatment to be continued regardless of the potential long-term outcomes, then
it must be continued.
Sarah presented a case to the
audience of a 12 week old, term born infant who was diagnosed with a rare
genetic condition which resulted in ventilator dependent hypoventilation with a
high likelihood that the infant would remain ventilator dependent for the rest
of her life. In addition, the condition
was associated with a range of other problems including cardiac arrhythmias,
gastrointestinal problems, urogenital problems etcetera. However, as the condition was so rare, little
is known about the likely prognosis making it difficult to properly inform the
parents of her likely long-term outcome.
Through discussion with the audience Sarah described the Utretcht model
of decision making which involves exploring, defining, analysing and weighing
up options before a moral decision can be made.
We thank Sarah for a very interesting
discussion.
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