Ethicians, ethicists and the goals of clinical ethics consultation

Abstract

We believe that clinical ethics consultation (CEC) has as its goal the delivery of healthcare in a manner consistent with the moral rules and the moral ideals. Towards this end, CEC pursues the instrumental ends of clarifying the limits of acceptable ethical disagreement and facilitating a choice among ethically acceptable alternatives. In pursuing these ends, healthcare ethics consultation (HEC) and CEC services confront three broad categories of questions: (1) questions of professional duty; (2) questions of law; and (3) questions of general morality. Professional duty questions concern what has been referred to as the "internal morality of medicine", and include questions such as the medical legitimacy of the goal(s) being pursued, or the acceptability of the means being employed. Questions of law concern themselves with what the law requires, permits or prohibits. Questions of general morality include all those not falling within the scope of the above categories. We submit that this has implications for the organization and structure of consultation services and HEC and for the methodology and processes employed in CEC. Thus: (1) questions of professional duty should be addressed only by physician members (whom we would distinguish by employing the term "ethicians") of the HEC or CEC service. The only role for non-ethicians under these circumstances would be in helping to resolve disagreements between/among professionals; (2) questions of law, in contrast, should be addressed only by the attorney member(s) of the HEC or CEC service; (3) questions of general morality may be addressed by the entire membership of the HEC or CEC service.

Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach

“…The personnel’s disappointment was based on the detection that patients had failed to comply with requests to taper down medication. This is in line with previous studies describing disagreement and divergent points of view among healthcare personnel [54–56]. Personnel seemed to have divergent views on what was ‘good care’.…”

Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review

“…Ethics consultations have been shown to help patients and personnel clarify ethical problems arising in daily health care practices and to improve collaborative decision-making (Fox et al 2007 ; Tarzian and ASBH Core Competencies Update Task Force 2013 ). Ethics consultations may have the goal of improving quality of care for the patient and/or for solving certain aspects of ethical conflicts that occur between healthcare personnel, patients and next-of-kin (Aulisio et al 2000 ; Paola and Walker 2006 ).…”

“…For example, in Japan, ethics consultation services may prioritize the review of scientific and clinical research (Fukuyama et al 2008 ) before case analysis and patient consultation (Adams 2009 ; Aulisio et al 2009 ; Tarzian and ASBH Core Competencies Update Task Force 2013 ). Ethical consultation services can be used in specific ways, such as in response to requests for assistance in addressing uncertainty or conflict regarding a value-laden conflict of interest (Aulisio et al 2000 ; Paola and Walker 2006 ). This can be between various stakeholders, such as patients, next-of-kin, healthcare personnel or the health organization (Adams 2009 ; Tarzian and ASBH Core Competencies Update Task Force 2013 ).…”