Stronger ethics support in childhood cancer care through shared responsibility
In Sweden, the responsibility of guiding difficult conversations about ethics often falls to healthcare professionals.
Ethics case-reflection rounds are a low-cost intervention that can reduce moral distress, improve decision-making, and strengthen patient safety. They lower staff turnover, enhance quality of care, and decrease the risk of complaints and adverse events. A big task for one person, especially fresh out of training.
Pernilla Pergert is senior lecturer in caring science with a special focus on care ethics.
“Although the legal responsibility for decisions about treatment are with the acting physician or nurse, the people we train, future facilitators of ethics case-reflection rounds, feel responsible for the ethical soundness of the care of the patients they discuss,” says Pernilla Pergert, senior lecturer in caring sciences with a focus on care ethics at the Centre for Research Ethics & Bioethics.
There is an ongoing conversation around what ethical competence should be required to work in ethics support. In the US, hospital ethicists have years of training. In Sweden, the responsibility of guiding these difficult conversations often falls to healthcare professionals. Since 2017, Pernilla Pergert and colleagues in a Nordic working group on ethics provide training for healthcare professionals to become facilitators of Ethics Case Reflection rounds. Their efforts are funded by the Swedish Childhood Cancer fund.
In a recently published article in HEC Forum, Pernilla Pergert and co-authors describe how the healthcare professionals undertaking this responsibility in paediatric oncology often feel responsible not only for guiding productive conversations, but also for creating a safe space, supporting team well-being, and ultimately helping ensure ethically sound care for the child in question. And they request stronger support.
The experience of ‘carrying the facilitator responsibility’ demands emotional sensitivity, ethical judgment, and the ability to create a safe space for open dialogue. Facilitators reported that without adequate training and support, this responsibility can be overwhelming and impact both their confidence and well-being.
“Our study shows that the clinicians who undertake training to facilitate these conversations, guiding the team through emotionally charged conversations, carry a profound and often unrecognised responsibility, and they request both recognition and support. And that support can come in a shift towards allying, carrying the burden of these difficult conversations together,” says Pernilla Pergert.
To safeguard both patient care and healthcare professionals’ well-being, the authors emphasise that systems must recognise and also fund the essential work of ethics facilitators in paediatric oncology. In practice, this means investing in continuous education of facilitators, distributing responsibilities across teams to reduce strain, strengthening the ethics infrastructure, and integrating ethics into clinical practice.
By Anna Holm Bodin
Bartholdson, C., Molewijk, B., Stolper, M. & Pergert, P. Carrying the Facilitator Responsibility: Experiences of Healthcare Professionals Under Training to Become Facilitators of Ethics Case Reflection Rounds in Paediatric Oncology. HEC Forum (2025). DOI: 10.1007/s10730-025-09572-7