Clinical Ethics Response Group (CERG) at Monash Children’s Hospital
The CERG was established in 2019 to support clinicians who encounter ethical challenges in their practice at Monash Children’s Hospital.
It aims to promote a culture of embedded ethical practice and decision making through:
- clinical ethics consultation – case referrals
- educational activities
- input into policy
The CERG meets when needed to consider ethical issues arising from clinical care within Monash Children’s Hospital. It provides confidential, multidisciplinary discussion and analysis of matters of ethical concern and provides an informed, reasoned and justifiable opinion on such matters. It is available as a service to be used at a clinician’s discretion – there is no onus to refer a case. The responsibility for all clinical decisions remains with the clinician. The CERG will not deliberate clinical competence, professional discipline, or resource allocation, nor does it provide legal advice.
Since 2020, the CERG has considered over 15 cases referred by clinicians at the Monash Children’s Hospital.
If you would like to discuss referring a clinical case or an ethical issue arising in practice, please contact:
Who can refer an issue to the CERG?
Any clinical member of the treating team may refer a case, the lead consultant should be aware of the referral.
How quickly will the CERG respond?
We commit to drawing together a panel of CERG members in a timeframe which meets the urgency of the case, usually within 48 hours.
How do I refer a case or ask a question?
You will be asked to provide anonymised information about the patient, diagnosis and current management plan and a brief summary of the current situation which prompted the referral.
What happens at a CERG meeting?
Currently all meetings are held on Webex.
The referring clinician attends to introduce the clinical case and answer clarifying questions. Other members of the treating team are welcome to attend as well.
Members of the CERG deliberate the ethical issues, and the referrer and other members of the team remain in the meeting, which lasts for about 1 hour.
The Clinical Ethicist writes up the ethics discussion and possible recommendations regarding the best way forward. This Ethics Report is provided to the referring clinician.
We ask for feedback from the referrer about the impact of the CERG discussion on the clinical decision making and the progress of the patient.
What clinical situations may give rise to ethical issues?
Areas to consider for paediatric case review may include:
- Children’s participation in decision making, including advanced care planning
- Withholding information from children
- Informed consent
- Withdrawal and withholding treatment
- Adolescent refusal of treatment
- Parent requests for experimental and unproven therapies
- Cultural dissonance/cross cultural care
- Equitable prioritisation of treatment
- Discharge planning and home care
- Communication/confidentiality between providers
CERG Members have all received training in ethics deliberation and are drawn from a wide range of clinical specialties including:
- Emergency Medicine
- Intensive Care
- Paediatric Gastroenterology
- Social Work
This broad membership provides a diversity of expertise and perspectives.