A Qualitative Exploration of a Clinical Ethicist’s Role and Contributions During Family Meetings

Abstract

Despite the interpersonal nature of family meetings and the frequency in which they occur, the clinical ethics literature is devoid of any rich descriptions of what clinical ethicists should actually be doing during family meetings. Here, we propose a framework for describing and understanding "transitioning" facilitation skills based on a retrospective review of our internal documentation of 100 consecutive cases (June 01, 2013-December 31, 2014) wherein a clinical ethicist facilitated at least one family meeting. The internal documents were analyzed using qualitative methodologies, i.e., "codes", to identify emergent themes. We identified four different transitioning strategies clinical ethicists use to reach a meaningful resolution. These transitioning strategies serve as a jumping-off point for additional analyses, future research, evaluating clinical ethics consultation, and overall performance improvement of a consultation service.

To have done everything

“…The ethicist thanked Sam for coming, and took the lead in facilitating a guided conversation. According to Bruce et al [7], an ethicist can take on several roles during a meeting, ranging from that of a leader to an observer. One possible role entails facilitating a meeting without dominating the discussion.…”

“…This ensures he has all the knowledge necessary to make an informed decision. This is what Bruce et al [7] call the elucidation strategy, where the ethicist asks the physicians to clarify the prognosis and its implications to the family. With the prognosis clarified, the family will be less likely to make judgements based on misunderstandings throughout the guided conversation.…”

“…The validation strategy ensures that the family feels heard and understood -it acknowledges them as important participants in the guided conversation who may be in the midst of their own bereavement process as the patient's condition deteriorates [7]. Internally, Sam was struggling with emotions of self-conscience such as guilt.…”

“…So, before he could decide, his feelings of guilt had to be addressed. In guiding the conversation, the ethicist allotted room for this and employed the validation strategy as an expression of empathy to further ensure that Sam felt that his opinions and anxiety were heard by the team [7]. This helps the surrogate decision-maker work through their emotions of self-conscience so that they can make a decision they feel at peace with.…”

“…The care team affirmed that his desire have his father cared for at home was valid, and that the palliative care unit could be a potential step towards that goal. Noticing that the validation strategy had been effective, the ethicist moved the conversation to decision making, by employing the elucidation strategy to shed light on what Bob would have wanted, and asking Sam questions about his values [7]. What would Bob consider a good quality of life?…”