Why doctors use or do not use ethics consultation

Orlowski, James P.

doi:10.1136/jme.2005.014464

Cited by 58 publications

(52 citation statements)

References 25 publications

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“…Clinicians often do not seek support because consultations are difficult to access, the process is time consuming or intimidating, the outcomes may be unhelpful, they may fear being scrutinized, fear loss of autonomy, or they may fear retaliation (Du Val et al, 2004;Førde, Pedersen, and Akre, 2008;Gaudine et al, 2011). Other possible reasons for underutilization include clinicians not being aware that a clinical support service exists, fear that a committee will worsen the situation (Gaudine et al, 2011) and placing a low value on shared decision making (Orlowski, et al, 2006). Two prospective studies by La Puma et al (1988Puma et al ( , 1992 collected descriptive information on consultations including the reason(s) for consultation, the characteristics of the patients involved, the clinicians' satisfaction with the service and whether they would use it again.…”

Section: Evaluation Of Ces Servicesmentioning

confidence: 99%

Clinical Ethics Support in Contemporary Health Care

Doran¹,

Kerridge²,

Jordens³

et al. 2016

Oxford Handbooks Online

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This chapter discusses clinical ethics support services (CES Services), the development of which has arisen to help respond to ethical issues arising in health care settings. CES services are comprised of an individual or group, usually in an organization, who can provide a suite of services to support all stakeholders in identifying and managing ethical issues they face. While there is a degree of consensus about the potential value of such services, they are also the focus of ongoing theoretical, methodological and political debates. The aim of this chapter is to provide health care managers with an account of how and why CES services are becoming a part of the contemporary organizational landscape of health care, and describe the concerns that bioethicists and others have raised regarding their role, function and dissemination.

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Section: Evaluation Of Ces Servicesmentioning

confidence: 99%

Clinical Ethics Support in Contemporary Health Care

Doran¹,

Kerridge²,

Jordens³

et al. 2016

Oxford Handbooks Online

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“…In the considered view of the care team, the lack of understanding and appreciation of medical facts by the substitute decision maker prevented her from making a decision that was in the patient's best interest. Disagreements between substitute decision makers and healthcare providers are not uncommon [13], and when disagreements arise, both parties are expected to collaborate to come to a decision that is in the patient's best interest [18]. However, in Ontario, cases in which a consensus cannot be reached in a reasonable time can be appealed to the Consent and Capacity Board.…”

Section: Discussionmentioning

confidence: 99%

What Are the Ethical Issues in Treating a Patient With Bilateral Leg Gangrene Incapable of Consenting to Amputation Secondary to Psychiatric Illness?

Taylor

McKay

Eid

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Bilateral and simultaneous lower extremity amputations unrelated to diabetes and peripheral vascular disease are uncommon, although they may be necessary in patients with severe blast injuries. Such amputations, however, usually are performed in patients who are able to understand and consent to the treatment. Case Description We present the case of a 29-year-old woman who experienced drug-induced psychosis and underwent substantial hypothermic injuries; most notably, irreversible frostbite injuries to both lower extremities, leading to dry and mummified gangrene. As a result of her psychiatric illness, fluctuating catatonic state, and lack of insight into her clinical condition, she was deemed incapable of making decisions regarding her medical care and her mother was made substitute decision maker. The orthopaedic service was consulted regarding possible surgical treatment of her gangrenous feet that were stable and aseptic after limb preservation efforts (including hyperbaric oxygen) had been tried without success. They recommended close clinical monitoring and continued psychiatric treatment. The family, including the substitute decision maker, citing the patient's best interest, rejected the recommendations of the surgical team and demanded immediate surgical transtibial amputation of both lower legs. Literature Review To our knowledge, such a unique case has not been reported. Clinical Relevance We examined the decision-making process, the difficulties of caring for such a patient, and the ethical issues that arose.

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“…6,48 LESSONS LEARNED Recognizing the Indications for an Ethics Consultation It is crucial for attending physicians to be able to recognize the need not only for additional medical expertise but also for ethics expertise in the form of an ethics consultation. These indications arise when there is a value-laden conflict about matters such as the goals of care and how to define the best interests and achieve the best care of the patient.…”

Section: The Trilateral Relationship In Medical and Ethics Consultationmentioning

confidence: 99%

“…Criticisms have focused on the need for rigorous and standardized clinical training of consultants and structured and systematic approaches to the evaluation of ethics consultation and quality improvement efforts that characterize other forms of medical consultation. [4][5][6] Given these criticisms and the emerging multidisciplinary nature of clinical ethics consultation as a clinical service in health care, it is important to examine just how the format of a clinical ethics consultation differs from, or is the same as, other medical consultations. Articles have thoughtfully appraised the association of psychiatric and ethics consultation and the importance of distinguishing the two in clinical practice.…”

mentioning

confidence: 99%