Perhaps the most important function of Hospital Ethics Committees is to provide ethics consultation to the hospital community. When physician and patient/family cannot come to agreement about an important treatment decision, the Hospital Ethics Committee is consulted. One or more of its members, with formal training in bioethics, will make a thorough evaluation and then present her findings to the committee at large. The entire Committee will then meet to discuss the case and make a recommendation, which the physician and patient/family will then discuss. If disagreement still remains, referral is made to the Courts for final adjudication
WHO CAN BE AN ETHICS CONSULTANT?
An ethics consultant should be a professional (preferably MD, MSN, MSW or PhD, or JD) with clinical experience. Also the consultant should possess advanced understanding of Clinical Ethics (preferably: MA in Health Care Ethics or Ethics Fellowship Program).
WHAT ARE THE CORE COMPETENCIES FOR A CONSULTANT?[i]
- Moral reasoning and ethical theory
- Common bioethical issues and concepts
- Health care systems
- Clinical contact
- The local health care institution
- The local health care institution’s policies
- Beliefs and perspectives of local patient and staff population
- Relevant codes of ethics and professional conduct
- Relevant health law
EXAMPLE SCRIPT FOR CONSULTANT’S FIRST ENCOUNTER WITH SURROGATE[ii]
“Hello, my name is ________. I am an ethics consultant and have been asked by your attending physician to come and talk with you. I routinely get involved in cases where difficult ethical decisions must be made about the best course of action to take. I want to assure you that I do not have an agenda of my own with preconceived answers about what’s right or wrong. My role is to talk with you and support you in considering the options that are available, and hopefully reach an outcome with which you are comfortable and that is in the best interests of your loved one. Is it ok if we talk?”
The primary characteristic of the facilitation approach is the open-ended way the ethics consultant approaches an ethics case with the attitude of assisting those involved in the conflict to arrive at an agreed-upon consensus.
GUIDELINES FOR EFFECTIVE BIOETHICS CONSULTATION[iii]
It is important that the Consultant understand the stated and latent interests of the participants. It is essential that the s(he) level the playing field to minimize disparities in power, knowledge, skill, and experience that separate the parties to the dispute. The Consultant should help the parties define their interests, search for common ground and maximize the options for conflict resolution. And the Consultant should ensure that the consensus can be justified as a “principled resolution”, compatible with the principles of bioethics and legal rights of patients and families.
ORR/SHELTON FORMAT FOR CONSULTATION REPORT[iv]
- Demographic Data
- Reason for Consultation Request
- Systematic Description of Case
- Medical Indications
- Patient Preferences
- Quality of Life
- Contextual Features
- Discussion and Analysis
[i] American Society of Bioethics and Humanities (2011)
[ii] D. Micah Hester (2008), Ethics by Committee
[iii] Dubler N & Liebman C (2004), Bioethics Mediation: A Guide to Shaping Shared Solutions
[iv] Jonsen A et al (2010), Clinical Ethics: A Practical Approach