An ethics consultation is designed to help patients, family members, surrogates and healthcare providers deal with difficult ethical issues that arise in patient care. Many of these issues have complex medical, nursing, legal, psychological, religious, and social dimensions, and can lead to conflict or uncertainty. An Ethics Consultation is a process by which trained consultants or an Ethics Consultation Sub-Committee of the Human Values and Ethics Committee responds to requests for help to resolve ethical conflicts, issues, or questions involving patient care. An ethics consultation is designed to identify ethical problems in the care of a particular patient, clarify these problems through a careful analysis of the values involved, promote discussion and dialogue of the values, issues and ethical problems involved with those directly involved in the case and resolve ethical problems through a process of shared decision-making. An Ethics Consultation is advisory. Patients, family members, surrogates and health care providers remain responsible for their own decisions. Clarification of the ethically accepted course of action can help the health care providers and patients navigate difficult clinical circumstances.
ETHICS CONSULTATION SERVICE
The ethics consultation service is a function of the Human Values and Ethics Committee that is provided through the Clinical Ethics Center. Consultations are conducted by trained clinical bioethicists who provide a prompt response to requests for assistance. The ethics consultation service is primarily intended as a resource when patients, family members, surrogates or healthcare providers feel that they have reached the limits of their own personal or professional ability to address ethical questions. Memorial Medical Center offers this advisory service free to patients, family members, surrogates and healthcare providers. The patient and anyone involved in caring for that patient can request an ethics consultation without fear of intimidation or reprisal. All discussions are confidential.
ETHICS CONSULTATION SUB-COMMITTEE
Some questions or issues necessitate the use of the Ethics consultation Sub-Committee, an ad hoc sub-committee of the Human Values and Ethics Committee. This sub-committee is convened for any of the following reasons: the ethics consultant believes that the issues are sufficiently complex that an interdisciplinary team approach would be beneficial, the person requesting the ethics consultation believes that the issues are sufficiently complex that an interdisciplinary team approach would be beneficial or external agencies, such as the Guardianship and Advocacy Commission, request a formal analysis of or recommendation about a case.
EXAMPLES OF ETHICAL PROBLEMS
What should a patient or surrogate do when he/she cannot understand what caregivers are saying, but tests and treatments continue anyway?
Who should make health care decisions when patients are unable to communicate or decide for themselves?
What should family members or caregivers do when they strongly disagree or are very uncertain about what is best for the patient?
When should life-prolonging treatments be started, continued or stopped?
What should family members and caregivers do when a patient refuses treatment that promises to be medically beneficial?
The following are examples of issues, which might give rise to these questions:
Withholding or withdrawing life support
Patient dementia or incapacity
DNR policy guidelines
Organ and tissue donation
In general, an ethical problem exists when it is not clear what is the ethically sound action or course of action or when people disagree about what is best for a patient. These and other ethical questions and concerns may develop to the point where conflict and serious disagreement results. Health care providers should rely on their education, experience and good judgment to prevent such escalation of disagreement. Discussing such situations with the Ethics Consultation Service might prove helpful before a true impasse is reached.
WHEN SHOULD AN ETHICS CONSULTATION
ETHICS CONSULTATION PROCESS
Memorial Medical Center's Ethics Consultation Policy (PDF) - This policy is an Adobe Acrobat file and requires Adobe Acrobat Reader to open. If you do not have Adobe Acrobat Reader installed on your computer, click here for a free downloadable copy of Adobe Acrobat Reader.