Background and Aims
Professionals need to work with children & parents to find solutions to evermore complex issues: rare disease innovative therapies, off-licence compassionate therapy and decisions regarding cessation of life-sustaining therapies.
With child-ethical dilemmas dominating headlines & social media we wished to explore ethical and legal support available to paediatricians facing such issues in district general hospitals (DGHs) compared to PICU consultants (represent UK-tertiary institutions) 

Method
Semi-structured group interviews in 5 London DGHs with paediatric/neonatal consultants & senior nurses vs. online-questionnaire for PICU consultants Re ethical challenges faced & support available

Results
Prevalent ethical dilemmas in both groups: WWLST, disagreement with family, and between teams. Both groups identified ‘on-the-job’ experience as predominant ethical education received, formal training rare. Both used colleague-support & mental health teams most frequently (p<0.05 PICU); PICU consultants found colleague’s advice (40%) & Clinical Ethics Committee (CEC) (40%) most helpful. DGH groups colleagues also cited community & safeguarding teams, religious support, tertiary colleagues & transport teams as sources of ethical support but strongly want formal ethics support, ideally experienced individual leading ethics-based discussions.


Comparison ethical support available.    DGH (5 groups)           PICU (10 groups)                               

CEC	                           	          0                                                                    8
Legal department	                          4	                                                                10
Individual ethicist	                           1	                                                                 4
Colleague advice	                           5	                                                                10
Doctor/nurse with ethics interest  0	                                                                 2
Mental Health Team	                    5	                                                                10


Conclusion
DGH clinicians face similar ethical dilemmas to tertiary care, albeit at decreased frequency. However, they face these predicaments without formal services available to children’s hospitals. This study highlights the need for the new UK-National Bioethics Group to support DGH teams, as well as tertiary units.

WHO YA GONNA CALL? ETHICAL SUPPORT AVAILABLE TO PAEDIATRICIANS