MORGAN STANLEY CHILDRENS HOSPITAL OF NEWYORK-PRESBYTERIAN ETHICS COMMITTEE

The pediatric ethics consultation service provides case consultation to members of the hospital community. The consultation service is not a decision making body and has no decision making authority in its' consultative role. The role of the consultation service is strictly advisory in nature: Decision making authority rests, as always, with the patient, their family and the care team. The purpose of the Consultation Service is not to replace the normal process of communication, interdisciplinary discussion, decision-making, and conflict management/resolution that occurs during patient care.

The process for case consultation services in MS-CHONY-P is as follows:

1. An ethics consultation can be requested by any member of the hospital community connected to the care of the patient, including the patient, their family, and members of the hospital staff including physicians, nurses, social workers, clergy, administrators, and other members of the care team.
   
   
2. The contact information and schedule for contacting the ethics consultation service can be found in the accompanying section entitled "How to contact the pediatric ethics committee."
   
   
3. The initial contact with the consultation service may be utilized as an informal "curbside" consult by members of the hospital community to discuss ethically charged situations. This informal discussion will remain confidential if requested, does not constitute a formal consult, and will not result in a note in the medical record.
   
   
4. If it is determined that a formal consultation is indicated, the person requesting the consult will be responsible for notifying the attending physician and all services immediately responsible for the care of the patient. The person requesting the consult, the attending physician, or a designated member of the care team will be responsible for ensuring that the family is informed that an ethics consult has been initiated and invite them to meet with the consult team if they wish. The only reason for the consult team to not meet with the family is if the family declines. The family may choose to meet with the consult team alone and/or in the consult meeting with the care team.
   
   
5. Consult teams will be led by the chairperson, vice-chairperson, or other designated team leader. Most consult teams will also include two other members of the consultation service. The consultation process will involve review of the medical record. It is recognized that some particularly difficult or institutionally complex cases will require consultation by the full pediatric ethics committee.
   
   
6. A consult meeting will be scheduled at the earliest possible time that the consult team, the care team, and the family can be assembled. This meeting should ideally occur within 24 hours after the request for consultation is made.
   
   
7. After meeting with the appropriate parties, the consult team with meet privately to discuss the case. The facts of the case, as well as the values, preferences, and interests of those with a stake in the decision, will be delineated. Moral dilemmas inherent in the case will be clarified and discussed. Moral reasoning will be applied to the case, morally permissible courses of action will be considered, and a response to the case will be formulated.
   
   
8. In the case of involvement of the full committee in a consult, the consult leader will arrange for an ad hoc meeting at the earliest possible convenience that more than half of the full committee can attend. Care team members and family members will be invited to attend. This ad hoc committee will then meet privately for deliberation. Thereafter, the consult team will resume the responsibility for documenting the committee's recommendations and providing follow up.
   
   
9. The results of the consult will be conveyed in a timely manner to the family and members of the care team, and a written consultation note will be placed in the medical record. This should occur within two days of the consultation. The family will be offered a copy of the consult document. Follow up will be provided by a member of the consult team.