Friday, September 18, 2009

Ethics Consultation: what is at stake and for whom?

Rosemary Flanigan
September 18, 2009

The recent issue of Cambridge Quarterly for Healthcare Ethics arrived at home and the entire issue is devoted to reviewing and assessing ethics consultation. One of the articles asks, “Is Consent Necessary for Ethics Consultation?” and it shows that consults may be called for participants other than the patient.

Thus one must ask what is at stake and for whom.

An example given is the cardiologist who is the attending physician for an elderly gentleman for whom he has provided care for over a decade. All along, the patient has insisted that he not end up debilitated and in a nursing home, but here it is, the fifth hospitalization in the past 18 months and the old gentleman is on mechanical ventilation, is in acute renal failure, has a variety of infections and a prolonged altered mental status.

The cardiologist has talked to the family and they have agreed that life support be withdrawn and their father allowed to die. It was at this point that the cardiologist requested an ethics consultation—not for the purpose of reviewing the case or checking the hospital’s DNR policies/terminal weans but whether or not this the “right” time to stop.

If this were your ethics committee, would you invite the family into the consult?

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1 Comments:

Blogger Marshall said...

I have been parties to ethics discussions (I don't recall that they've ever proceeded to full committee consultations) for the purpose of "covering" the physician. Families have not been invited, but as in the case you cite, the families were not in conflict with the physician or among themselves.

I have also been part of a full consultation when the physician and family were in agreement, but the requested procedure was in itself ethically complex. In that case the Ethics Committee had concerns both for the patient (who was present, and also in agreement) and for the hospital.

Part of our human experience is having more than one relationship within which to be responsible, and struggling to balance those multiple, sometimes conflicting, responsibilities. Other voices (in this instance, the Ethics Committee) can certainly give perspective in that process.

Saturday, September 19, 2009  

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