Health care professionals often encounter ethical issues or dilemmas in their daily work, especially in complex and uncertain situations. Sometimes a patient’s desires differ from their family’s, or a clinician’s assessment. Well-meaning people can have different views on the right thing to do, or even what the best care plan is for the patient. These issues or dilemmas can affect the quality of care, the well-being of patients and providers, and even the relationships among the health care team
Fortunately, ethics consultations can help you in these situations. Clinical Ethics Consults are resources to help address these situations with multiple complex points of view. They provide guidance and support to patients, families, physicians, and the health care team on ethical issues or dilemmas that arise in care settings. Ethics consultations can help you clarify ethical issues and values, facilitate communication and discussion, provide expertise and educational resources, and promote respect for the values, needs, and interests of all participants.
In this article, I will explain how ethics consultations can be helpful for you in various situations, what ethics consultation looks like in practice, and how ethics consults prioritize people in the health care process. I will also share some studies that show the impact and outcomes of ethics consultation on clinicians’ perceptions and patient-related outcomes.
Studies that explain how ethics consultation can be helpful
There are several studies that have evaluated the impact and outcomes of ethics consultation on clinicians’ perceptions and patient-related outcomes. Here are two examples:
Wocial et al. (2016) examined the impact of ethics consultation on clinicians’ perceptions of a patient’s plan of care and on the personal values of clinicians who participated in an ethics consultation. The study found that over 60% of participants felt the consultation helped clarify the values of the patient and/or patient’s family and helped them clarify their own values. Only 32% of participants indicated the patient’s plan of care changed as a result of the ethics consultation, yet 75% indicated their confidence in the plan of care increased as a result of the ethics consultation. The study also found that ethics consultation can help clinicians clarify their own values, while helping them clarify the values of patients and patients’ families.
Au, et al. (2018) found that 88% of people (383 out of 435) thought it was helpful to have the ethics consultant come and talk with them. 26% (113 out of 431) of people didn’t always agree with what the ethics consultant said and felt more stress. But overall, they found that ethics consultations increased the chances of reaching a consensus on what to do by 4 times. Finally, ethics consultations decreased the length of stay by almost 5 days.
These studies show some of the benefits of ethics consultation, such as clarifying values, increasing confidence, achieving consensus, and decreasing resource utilization. Ethics consultation can help you to make ethical decisions that are consistent with your professional standards and personal values, as well as with the patient’s needs and preferences.
What does an ethics consultation look like?
The goal of ethics consultation is to support informed, deliberative decision-making on the part of patients, families, physicians, and the health care team. By helping to clarify ethical issues and values, facilitating discussion, and providing expertise and educational resources, ethics consultants promote respect for the values, needs, and interests of all participants, especially when there is disagreement or uncertainty about treatment decisions.
Ethics consultants who provide ethics consultation services seek to balance the concerns of all stakeholders, focusing on protecting the patient’s needs and values. They serve as advisors and educators rather than decision-makers. Patients, physicians, other members of the care team, healthcare administrators, and other stakeholders should not be required to accept the consultant’s recommendations. Physicians and other institutional stakeholders should explain their reasoning when they choose not to follow the consultant’s recommendations in an individual case.
Those who provide ethics consultation services should have appropriate expertise or training—for example, familiarity with the relevant professional literature, training in clinical/philosophical ethics, or competence in conflict resolution— and relevant experience to fulfill their role effectively.
Here are some of the key aspects of ethics consultation:
- Interdisciplinary approach: Ethics consultation involves a team of professionals from different disciplines, such as medicine, nursing, social work, chaplaincy, and ethics. This interdisciplinary approach ensures that all relevant perspectives are considered when making ethical decisions.
- Facilitation of communication: One of the main roles of the ethics consultant is to facilitate communication among all parties involved in the decision-making process. This includes helping to clarify values, goals, and concerns, and ensuring that everyone’s voice is heard.
- Identification and analysis of ethical issues: The ethics consultant helps to identify the ethical issues at stake and provides an analysis of the options available. This analysis is based on ethical principles and values, as well as relevant laws and policies.
- Recommendations: Based on the analysis, the ethics consultant may provide recommendations to the health care team, the patient, and the family. These recommendations are not binding but serve as a guide for decision-making.
- Documentation: The ethics consultation process is documented in the patient’s medical record to ensure transparency and accountability.
Overall, ethics consultation is a valuable resource for addressing complex ethical issues in health care settings. It provides a structured process for decision-making that is guided by ethical principles and values.
Examples of ethics consultation scenarios
Ethics consultation can help in different situations where ethical challenges or questions arise in health care settings. For example, some of the common scenarios that ethics consultation can address are:
- Conflict between a family or medical care team regarding a patient’s plan of care: When there is disagreement or lack of communication among the patient, family, or care team about the goals, benefits, or risks of treatment options.
- Identifying appropriate decision maker: When there is no advance directive or designated surrogate for a patient who lacks decision-making capacity or when there is doubt about the validity or applicability of an advance directive or surrogate decision.
- Non-Beneficial/Experimental/Futile medical requests: When a patient or family requests a treatment that is not medically indicated, not supported by evidence, or not likely to achieve the desired outcome.
- Quality-of-life concerns: When there is uncertainty or conflict about how to respect the patient’s values, preferences, and dignity in relation to their physical, mental, emotional, social, and spiritual well-being.
- Advocacy for vulnerable patients: When a patient faces discrimination, injustice, abuse, neglect, or coercion that affects their access or quality of care.
- Moral distress: When a health care professional experiences emotional or psychological distress as a result of being unable to act in accordance with their moral values or obligations due to external constraints or conflicts.
- Questions about how the hospital’s Mission applies to holistic patient care: When there is confusion or doubt about how to apply the principles and teachings of the hospital’s faith-based Mission to the care of patients who have diverse backgrounds, beliefs, and needs.
How ethics consults prioritize people
Ethics consults are not only about resolving ethical issues or dilemmas, but also about respecting and supporting the people involved in the health care process. Ethics consults prioritize people by:
- Discussing relevant interpretations to ensure mutual understanding: Ethics consultants help to clarify the facts, perspectives, and assumptions of the patient, family, and care team, and to identify any gaps or misunderstandings that may affect the decision-making process.
- Identifying pertinent ethical values and goals held by the parties involved: Ethics consultants help to elicit and acknowledge the moral values and goals that guide the patient, family, and care team, and to explore how they relate to the ethical principles and standards of health care practice.
- Impartial facilitation to build empathy and focus on the patient’s holistic needs: Ethics consultants help to foster a respectful and collaborative dialogue among the patient, family, and care team, and to facilitate a consensus or compromise that respects the patient’s needs and values in relation to their physical, mental, emotional, social, and spiritual well-being.
- Discerning how our Mission is calling us to best care for the patient: Ethics consultants help to apply the principles and teachings of the faith to the care of patients who have diverse backgrounds, beliefs, and needs, and to uphold the Mission of our organization to provide total care of the patient’s mind, body, and spirit.
Conclusion
Ethics consultation is a valuable service that can benefit both patients and providers in various situations. THey can help you to clarify ethical issues and values, facilitate communication and discussion, provide expertise and educational resources, and promote respect for the values, needs, and interests of all participants. Ethics consultation can also help you to make ethical decisions that are consistent with your professional standards and personal values, as well as with the patient’s needs and preferences.
If you are interested in learning more about ethics consultation or requesting an ethics consultation for a specific case, comment below or reach out to me on twitter at @PaulWagle. Let me know if I can be helpful with any ethical questions or challenges you encounter in your health care practice.
I hope this article has been helpful and informative for you in understand how clinical ethics consultations can help you. I welcome your feedback and suggestions on how we can improve our service and our communication with you. Thank you for reading this article and for your commitment to ethical health care!