For over 15 years, The Royal Children’s Hospital (RCH) Children’s Bioethics Centre, also known as the CBC, has been supporting clinicians across the hospital navigate complex decisions with confidence. The Centre, which is funded by philanthropy, uses bioethics, a field of study related to moral philosophy, deals with healthcare and human biology, to help drive ethical decision making.
According to Professor John Massie and Professor Lynn Gillam, Directors of the CBC, bioethics is actively helping clinicians make stronger decisions.
“Ethics provides us with a way of thinking through problems. It helps us consider children and their own independent interests, and how decisions may impact them now as a child, but also as an adult in the future,” John explained.
Using this understanding, experts at the CBC organise consultations and facilitate discussions with clinicians, guiding them through complex scenarios. These sessions act as a safe space for staff to raise concerns or ethical problems, ranging from the refusal of care to the use of restraint.
“We give clinicians the opportunity to sit down and think slowly, carefully and deliberately about each situation and possible ways of moving forward. From there, they can come to a considered decision which explicitly considers ethical values,” Lynn shared.
On top of speaking to clinical staff, experts at the CBC also consult with families directly, giving them the chance to express themselves without their child’s treating team present.
“This opens up space for families to contribute, share their opinions, and have more confidence in the decision. It also helps ensure their point of view has thoroughly been considered,” Lynn added.
The process gives both the clinical team and families the confidence that their child is receiving the best possible care, while assuring them that each decision has the child’s long-term health in mind.
“Over the years, we have been involved in a number of instances where parents or the child themselves were reluctant to have some form of intervention, worried about side-effects or feeling that the treatment wasn’t really necessary,” John explained.
“Through the process of an ethics consultation, we have been able to work with the treating team to imagine this child in the future, at age 25, asking, ‘why did you make that decision about me?’ and consider a good reason from that young adult’s perspective. This framing helps us to identify what is ethically important in the situation,” he continued.
On top of consultations, the CBC provides departments across the RCH with personalised workshops to improve their ethical thinking and build trust.
“One of our missions has been, and continues to be, building trust with clinicians. It’s very easy to see ethics as judgmental. So it is important for us to draw them into the ethics realm, inviting them to come and speak to us,” John explained.
The Centre’s impact reaches far beyond the RCH. The CBC delivers educational pieces including an annual conference that connects over 400 clinicians from around the world, a podcast that now has over 60 episodes as well as academic articles, books and more.
Both John and Lynn are incredibly grateful to the generosity of donors and the RCH Foundation. The Centre is now the cornerstone of the hospital, ensuring that clinicians can navigate complex problems with ease, and that children receive the best possible care.
“There is a culture at the RCH of thinking about things in an ethical way and being willing to discuss hard things. And of course, it’s discussing the hard things that makes care better,” Lynn emphasised.
“We are incredibly grateful to the generosity of donors and the RCH Foundation for helping drive ethical thinking not just at the RCH but at hospitals everywhere. This mindset is transforming paediatric healthcare for the better,” she concluded.