Ethics Consultation: Skills, Roles, and Training

Abstract

A clinical ethics consultant gathers information firsthand at the patient's bedside. The consultant's special clinical skills include the ability to identify and analyze ethical problems; use reasonable clinical judgment; communicate effectively; negotiate and facilitate negotiations; and teach others how to construct their own ethical frameworks for medical decision making. Appropriate roles for the consultant include those of professional colleague, negotiator, patient and physician advocate, case manager, and educator. The training necessary for an ethics consultant includes substantial patient care experience, instruction in health care law and moral reasoning, and preparation in medical humanism. We favor a clinical model for ethics consultation. When urgent care is needed, other consultants promptly see the patient; the clinical ethics consultant can be expected to do the same.

Ethics consultation in social work

“…Ethics consultants in social work can assume a variety of roles, depending upon their employment setting and responsibilities, and their particular areas of expertise. These Downloaded by [University of Auckland Library] at 14:42 08 December 2014 roles include those of professional colleague, educator, mediator, advocate, and case manager (Goldman, Lee, & Rudd, 1983;La Puma & Schiedermayer, 1991). As a professional colleague, the ethics consultant's mission is to provide a social worker with a thoughtful reaction to ethical issues or dilemmas presented to him or her.…”

“…Ethics consultation-first provided primarily in hospitals-began in the late 1960s and early 1970s at Pennsylvania State University, the New Jersey College of Medicine, and the University of Wisconsin (Fletcher, Quist, & Jonsen, 1989;La Puma & Schiedermayer, 1991, Pellegrino (1978 and Siegler (1978Siegler ( ,1979 published several influential papers that proposed a role for "clinical ethics" as a separate field of expertise, and in 1985 the University of California, San Francisco, and the National Institutes of Health co-sponsored a conference on ethics consultation (Bermel, 1985). By 1990 ethics consultation in health care had developed so substantially that a professional journal devoted to the subject, the Journal of Clinical Ethics, began publication (La Puma & Schiedermayer, 1991).…”

Bioethicists: Practitioners of applied philosophy

“…If values cannot be identified, then the bioethicist recommends that medical decisions be made that foster the patient's best interests in light of his or her clinical status and prognosis, and the burdens and benefits of the proposed therapy (Freedman, 1999). In this latter situation, there are often no friends or family to turn to and the bioethicist functions as an advocate for the patient (La Puma & Schiedermayer, 1991).…”

Ethical issues for the consultant in the general hospital

“…Its considerations generally include attention to the following key principles [32,33,35]: balancing benefits and risks in the care of patients; expecting that clinicians utilize their professional expertise to maximize a positive for their patients; respecting the right of the patient to honest disclosure, informed consent and shared decision making; acknowledging the role of families of the patient in medical decision making; recognizing that the patientdoctor relationship and its disturbance lie at the heart of most ethical dilemmas; recognizing that physicians have no responsibility to provide treatments that are not medically indicated. Patients are not entitled to get whatever treatment they demand; being aware that in these times of concern for cost-effectiveness and allocation, physicians cannot avoid the need to select which patients receive scarce medical resources as long as equitable procedures are applied to allocation decisions; being sensitive to the cultural practices and values of patients is essential in responding appropriately to ethical problems; and being aware of the power differential between individuals and groups involved in particular cases.Another avenue for seeking resolution of seemingly intractable professional or clinical dilemmas with an ethical dimension is usually consultation with the local or regional C-L colleagues who sometimes meet on a regular basis.…”