ETHICAL REFLECTIONS VIA THE DILEMMA METHOD IN A PEDIATRIC NEURO-ONCOLOGY DEPARTMENT

Abstract BACKGROUND: Professional care for children with a brain tumor can bring considerable ethical questions in clinical practice. These questions can be burdensome and cause distress among professionals, parents and patients. Awareness and skills to bring these aspects into a respectful discussion among colleagues can be meaningful and alleviate the distress. Our objective is to give overview of the ethical case deliberations which took place during a monthly multidisciplinary meeting on the pediatric neuro-oncology department. METHOD: To describe the type of ethical case deliberations as spontaneously proposed and selected by the team members for discussion. To identify main values in the care process for professionals via the dilemma method in monthly meetings led by a trained facilitator. RESULTS: The monthly meetings were visited regularly by 9-14 diverse professionals (median 10) of the team: nurses, oncologists, social worker, psychologist, educational specialist. The selected moral questions concerned children with a brain tumor between 4-13 year old (median 9) with following ten subjects: 3 not sharing the infaust prognosis with a child, 2 avoiding medical care in follow up /treatment, 2 cultural different approach for food and drink intake, 2 crossing professional boundaries and 1 time worries about emotional safety of a child. The main values that were recognized to play crucial role in the care process were honesty, respect, autonomy, quality of life, health, tolerance, courage and safety. The participants felt supported in their professional skills by sharing reflections on personal moral considerations and by openly discussing different views and experiences of other participants. CONCLUSION: The monthly ethical case discussions disclose high lights in the burden of professional care in pediatric neuro-oncology. These meetings about moral questions are supportive in the competence of the professionals to recognize and communicate about these important dilemmas.