Breaking News

Role of the Bioethics Committee in neonatal care

by Laurence B. McCullough, Ph.D.
Professor of Medicine and Medical Ethics
Center for Medical Ethics and Health Policy
Baylor College of Medicine

Ethical issues in neonatology frequently concern end-of-life decision making. And most hospitals have ethics committees that consider such sensitive issues in a humane and equitable manner. To assure that decisions are made with the least bias, ethics committee members come from various backgrounds and disciplines. The Texas Children’s Hospital Bioethics Committee comprises physicians from general pediatrics and the full range of pediatric subspecialties (including neonatology), nursing, social work, pastoral care, risk management, and hospital administration, as well as community representatives.

Anyone can request an ethics consultation. At Texas Children’s, in response to such requests, the ethics committee chairman notifies the attending physician of the request (when he or she did not request the ethics consult) and then convenes a subcommittee of the Bioethics Committee. The subcommittee meets with the patient’s medical team, with the patient’s parents and other family members and, in the case of adolescents, with the patient, as well. The subcommittee’s goals are

• to identify the nature of the ethical problems in the case and
• to work with the team, the patient’s family, and the patient (as appropriate) to identify acceptable ways to manage the ethical issues without referring the case to the full committee.

In those rare circumstances where agreement cannot be reached, the case is referred to the full committee. In addition to consulting on individual cases, the Committee develops and implements hospital policies in ethics-related areas and educates the hospital’s professional staff about ethics.

To guide the professional staff, the Texas Children’s Bioethics Committee has created End of Life Decision Making, a set of guidelines accessible on the hospital’s Intranet. In addition, the Nursing Department has created an Ethics Tool Kit, which also is available to staff on the hospital’s Intranet.