Developing clinical ethics support for paediatric practice at Hospital Al-Sultan Abdullah / Muhamad Izwan Ab Manan

The field of clinical ethics has played a crucial role in addressing the ethical issues and dilemmas that healthcare professionals face in their clinical practice. Clinical ethics support services have evolved into the institutional ethics support provided within health systems in various countries around the world, with three primary functions- (1) case consultation, (2) education, and (3) policy review or development. Unlike adult medicine, paediatric practice presents unique ethical challenges that are not frequently observed in adult patient care. While ethical issues in paediatrics are relatively common, the number of paediatric ethics consultations was found to be significantly low in general. That can imply that clinical ethics support services have not been utilised to their full potential in paediatric practice. The need for clinical ethics support for paediatric practice has become more apparent with the advancement of modern medicine due to the numerous ethical quandaries related to paediatric care that have arisen as a result of this. This dissertation explores the development of paediatric clinical ethics support services in various countries and how they have been utilised. In the case of Hospital Al-Sultan Abdullah (HASA), key informant interviews (KIIs) revealed that the paediatricians faced a number of ethical issues related to clinical decision making, surrogate decision making, refusal of treatment by parents, end-of-life issues, and resource allocation issues. The recommendations in this dissertation took into account the ethical issues identified as well as the opinions of the paediatricians. The recommendation focuses primarily on promoting clinical ethics consultation services and the clinical ethics committee at HASA. Enhancing case consultations through grand rounds, providing ethics education and training, as well as guidelines and policy development in paediatric practice, have been highlighted. It is hoped that this dissertation will contribute to the literature on clinical ethics in Malaysia and will also significantly impact the development of a clinical ethics support service in paediatric practice in the country.