Use of the Medical Ethics Consultation Service in a Busy Level I Trauma Center: Impact on Decision-Making and Patient Care

Abstract

The purposes of this study were to assess reasons for consultation of the Ethics Consultation Service for trauma patients and how consultations impacted care. We conducted a review of ethics consultations at a Level I trauma center from 2001 to 2010. Data included patient demographics, etiology of injury, and timing/type of the consult, categorized as: shared decision-making, end-of-life, privacy and confidentiality, resource allocation, and professionalism. Consultations were requested on 108 patients (age mean, 46.5 ± 20 years; Injury Severity Score mean, 23 ± 14; length of stay [LOS] mean, 44 ± 44 days), 0.50 per cent of all trauma admissions. Seventy-seven per cent of consultations occurred in the intensive care unit. End of life was the most common consultation (44%) followed by shared decision-making (41%). Average time to consultation was 25 days. Shared decision-making consults occurred much earlier than end-of-life consults as evidenced by a lower consult day/LOS ratio (consult day/LOS = 0.36 ± 0.3 vs 0.77 ± 0.3, P = 0.0001). Conclusions consisted of: 1) ethics consultation on trauma patients are most commonly for end-of-life and shared decision-making issues; 2) most ethics consultations occur while patients are in the intensive care unit; and 3) earlier ethics consultations are likely to be for shared decision-making issues.

To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization

“…Another study conducted by La Puma et al showed that 74% of the cases requested HCEC for the decisions to forgo life-supporting treatments, 46% for resolving disagreement, and 30% for assessing patient competence for decision-making [ 15 ]. A recent study conducted by Johnson et al reported that the requesters sought assistance with end-of life issues in 47% of the cases, in 41% of cases for shared decision-making, and in 14% of cases for professionalism [ 5 ].…”

“…All the hospitals with more than 400 beds in the U.S. provided HCEC [ 4 ]. Johnson et al also reported that requests for HCEC grew steadily from 2000 to 2008 [ 5 ]. According to these studies, the demand for HCEC to resolve ethical conflicts and difficulties in clinical practice has increased tremendously.…”

Needs assessment for providing clinical ethics consultation services in Tehran

“…4,7,17,25 Similar studies in western countries have shown that decisions regarding intensive care in the end-of-life are challenging. [26][27][28][29][30] The reason may be that in other countries, there are several laws and regulations regarding the issues related to autonomy that clarify the physicians' obligations and patients' rights, whereas in Iran, absence of law and vagueness in the related regulations result in ambiguities and questions regarding balance between beneficence and respecting patient's autonomy.…”

Perfil das consultorias de bioética clínica envolvendo famílias que dificultaram a resolução de problemas

“…Os adolescentes, com idades de 12 a 18 anos, e os idosos, com idades acima de 60 anos, tiveram demandas semelhantes, cada grupo com 10 consultorias (13,51%). Em relação às características citadas, outras fontes bibliográficas também permitem constatar a concordância em relação à distribuição equilibrada quanto ao sexo 17 e a predominância da faixa etária adulta 18 .…”