The Center for Bioethics at Children’s Hospital Los Angeles supports patients, families, researchers and health care teams. We give guidance and education on ethical questions related to children’s treatment, research and health policy.
The field of bioethics studies moral, social and philosophical issues related to medical care. At Children’s Hospital, our Center for Bioethics focuses on ethical dilemmas in caring for children. Our interdisciplinary team members are respected experts in pediatric bioethics and health policy.
About the Children’s Hospital Los Angeles Center for Bioethics
CHLA is a national leader in pediatric health care, education and research. We care for vulnerable children with a wide range of health conditions in one of the most ethnically and socioeconomically varied regions in the country. We see the intersection of advanced care, innovative research and limited resources in a diverse community. This combination leads to critically important bioethical questions relating to:
- Communication
- Equitable care
- Informed consent
- Participation in research
- Representation
- Resource allocation
- Shared decision-making
The Center for Bioethics, established in 2021, is the only center of its kind in Southern California. Our work supports every aspect of CHLA’s mission to create hope and build healthier futures. We do this through patient- and family-centered care, scientific discovery, health care education and community partnership.
Our Goal
We aim to foster the highest level of excellence in patient-focused and family-centered care. We work to:
- Nourish the moral community (a group of people bound together by shared values and standards) at CHLA by creating space for moral reflection and reasoning
- Support the compassion and resilience of faculty, staff and trainees
- Promote ethically responsible clinical care that follows best pediatric practices and aligns with the values of patients and families
- Encourage ethically responsible, leading-edge research through engagement with investigators, patients, families and communities
- Provide meaningful scholarship in pediatric bioethics through research, education and policy development
- Develop and advocate for public policy that allows children to flourish
Center for Bioethics Initiatives
Our work at the Center for Bioethics extends throughout CHLA and the greater community. Our pediatric bioethics efforts include:
- Clinical Ethics: Provides 24/7 clinical ethics consults, expanding upon the work of the Ethics Resource Committee. We support providers, patients and families facing ethical dilemmas in clinical care and make sure everyone’s voice is heard. We identify the core shared values that open solutions to challenging conflicts.
- Research Ethics: Supports investigators and reviewers at The Saban Research Institute at any clinical or translational research stage.
Our Bioethics Research
Our team members actively study bioethical issues and welcome research collaborations. We work with investigators at CHLA, in Southern California and across the nation to study ethical topics such as:
- Pediatric decision-making during critical illness and at end-of-life
- Fair resource distribution during critical shortages and public health emergencies
- Genomic research in diverse populations, with a focus on empowering children and families with ownership and control of their genomic data
- Shared decision-making in pediatric health care
- The impact of poverty, racism and other challenging experiences on children's health
Hurley-Tedford Visiting Professor
The Hurley-Tedford Visiting Professor event brings a renowned bioethics expert to CHLA once a year. The speakers meet with Children’s Hospital staff to share their expertise on bioethical issues and explore opportunities for collaboration and growth. A generous endowment from CHLA residency alumni supports this event.
Hurley-Tedford Annual Ethics Writing Workshop
The Center for Bioethics holds an annual writing workshop. This endowed workshop encourages CHLA faculty, staff and trainees to write about important bioethical issues in pediatric health care.
Winning authors may receive a cash prize. They also have the opportunity to work with our team to develop their essays for submission to a bioethics journal.
What Distinguishes Pediatric Bioethics From the Broader Field of Bioethics?
Pediatric bioethics focuses on ethical issues within the context of health care for children. Unique challenges in pediatrics include:
- Tensions between individual autonomy, parental authority and a child’s best interests
- Role of a child and parent in informed consent versus assent
- Appropriately involving children and adolescents in medical decision-making
Autonomy vs. parental authority
Autonomy recognizes a person’s right to make decisions for themselves and act freely on these choices. However, the ability to understand the risks, benefits and alternatives to treatment is something that develops over time as a child matures. Young children can’t always understand or communicate their wishes. Even older children may not have legal authority to make medical decisions on their own.
Health care providers and parents seek to make decisions that are in the child’s best interest. This standard is subjective and based on personal values and morals. As a result, ethical concerns may arise when providers and parents disagree about what kind of care is best for a child.
Consent vs. assent
Consent is the process of getting permission or refusal from patients or research participants. Consent requires patients to have autonomy, meaning they have the ability to understand risks and benefits and the legal authority to make decisions. In most cases, children can’t give consent until age 18.
However, many children do have the ability to understand and make decisions. In these cases, providers or researchers ask children for their assent – their agreement. To provide meaningful assent, children should receive adequate information and have the chance to have their questions answered in a way that they can understand.
This process protects children's rights to voice their preferences and respects them as individuals. But ethical questions may arise when providers aren’t sure whether to include a child and ask for assent, or when children and their parents disagree.
Adolescent decision-making
Adolescents are a unique population. They are more mature than children, but their cognitive and emotional skills are still developing.
Health care providers consider many factors when evaluating the decision-making of adolescents. In addition, some states allow minors to make their own health care decisions. Our team can guide providers through these concerns and the related laws when caring for adolescents.
Bioethics at Children’s Hospital Los Angeles
We offer a range of bioethics services for patients, families, providers and researchers. Learn more about our bioethics services.