Suicidality in Bereaved Parents Within Pediatric Institutions: Recommendations for Managing Ethical Challenges

Objective: Illness remains among the leading causes of death for children in the United States. Bereaved parents are at risk for poor psychosocial outcomes, including suicidal ideation and death by suicide. Although professional ethics and national standards recommend psychosocial care for parents of children with chronic or life-limiting illnesses, there are ethical challenges associated with managing parent suicidality within a pediatric institution. Method: We present two cases illustrating the ethical challenges of responding to suicide risk in parents experiencing bereavement within pediatric institutions. Lack of systematic psychosocial support or standard operating procedures (SOP) in both cases resulted in several ethical concerns and suboptimal clinical care. Results: We reference the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct (American Psychological Association [APA], 2017) and apply an ethical framework (Andrews, 2021) for delivering psychological services to parents in pediatric institutions in these two cases. We describe the ethical challenges of: Conflicting interests of parent and child, multiple relationships, documentation and billing, informed consent, provider competence, and systemic racism within health care and law enforcement when managing suicide risk of grieving parents. Conclusions: We discuss practices for the ethical management of suicide risk in parents experiencing bereavement within a pediatric institution. We provide recommendations for clinical practice and organizational policy, as well as strategies to improve assessment and management of parental suicidality and suggestions for future research. Implications for Impact Statement Clinical management of suicide risk in bereaved parents within pediatric institutions is complicated by a range of ethical concerns, which often underlie organizational barriers and practical challenges of caring for these parents. This article includes illustrative case examples, provides clinical and practical recommendations, and prepares pediatric psychologists and health care settings to develop standardized operating procedures to care for this vulnerable population.