Ethical climate in contemporary paediatric intensive care

• Published in: Journal of medical ethics Vol. 47; no. 12; p. e14
• Main Authors: Moynihan, Katie M., Taylor, Lisa, Crowe, Liz, Balnaves, Mary-Claire, Irving, Helen, Ozonoff, Al, Truog, Robert D., Jansen, Melanie
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Institute of Medical Ethics 01.12.2021; BMJ Publishing Group LTD
• Subjects: Child & adolescent mental health; children; Decision making; ethics committees/consultation; health care for specific diseases/groups; health personnel; interests of health personnel/institutions; Medical ethics; Nurses; Original research; Pediatrics; Perceptions; Psychiatric-mental health nursing; United States > US; Sweden; health care for specific diseases/groups; children; ethics committees/consultation; interests of health personnel/institutions; health personnel
• ISSN: 0306-6800; 1473-4257; 1473-4257
• DOI: 10.1136/medethics-2020-106818

Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to measure it fail to capture nuances of the PIC environment, and sought to address existing gaps by developing an EC framework for PIC founded on ethical theory. In this article, we propose a Paediatric Intensive Care Ethical Climate (PICEC) conceptual framework and four measurable domains to be captured by an assessment tool. We define PICEC as the collective felt experience of interdisciplinary team members arising from those factors that enable or constrain their ability to navigate ethical aspects of their work. PICEC both results from and is influenced by how well ethical issues are understood, identified, explored, reflected on, responded to and addressed in the workplace. PICEC encompasses four, core inter-related domains representing drivers of EC including: (1) organisational culture and leadership; (2) interdisciplinary team relationships and dynamics; (3) integrated child and family-centred care; and (4) ethics literacy. Future directions involve developing a PICEC measurement tool, with implications for benchmarking as well as guidance for, and evaluation of, targeted interventions to foster a healthy EC.