Tuesday, April 20, 2010

Physicians and Ethics Consults -- Why so Few?

Rosemary Flanigan
April 20, 2010

Why, in my 17-year experience with ethics committees, do so few physicians call for consults?

I am surmising that when faced with a “problem,” they consult one another. Most of them, I think, see the “problem” not just as a professional quandary but as a moral one, and they are eager to do “the right thing.”

So let us say two of them are standing in a doorway discussing a “problem” (and I’m sure their talk is laced with numbers) and let’s say they reach different conclusions of “the right thing to do.”

OK, I would imagine (having never been party to such a consult), they disagree and the attending goes into the room and takes care of the patient as he/she had just argued. The other physician walks down the hall to take care of other business.

What is at stake beneath these differing care plans? Ultimately, I allege, it’s virtue ethic: what it means to be a good physician!!! And doctor to doctor can be argued because they are both part of the “fraternity.”

But to argue interpretations of “the right thing to do” with non-physicians might, for some of them, be questioning their very essence as a “good” doctor.

YES, that can be true of NP’s, too. But my non-evidence-based judgment is that nurses might be more open to discussion of their “virtus,” their good habits, than are physicians.

Do blow me out of the water if you disagree!!!!



Blogger Maurice Bernstein, M.D. said...

I would say that the hospital ethics committee or clinical ethical consultant does not evaluate the "virtue" of a physician and has been repeatedly stated over the years, the ethics committee is not a hospital "police" committee. Differences in prognosis and approaches to therapy that will be described to the patient or surrogate is a medical matter to be decided by physicians themselves. They may have differences of opinion which eventually has to be resolved but the ethics committee or consultant does not make such medical decisions. The ethics committee's duty is, to establish whether an ethical issue exists and if so to provide the ethical and legal (as it applies to ethical issues) education to the stakeholders, mediate and by this facilitate the stakeholders arrival at a final decision.

I think there is still confusion as to the role of hospital ethics committees by the medical staff. I have gotten requests from the nursing staff who read in the doctors orders "Discontinue endotracheal intubation if OK with ethics committee"..as though it is the ethics committee's responsibility for determining whether the patient could breath on his own or whether the tube should be removed so that a tracheostomy will be performed. Obvious ignorance regarding the role of the ethics committee. And obviously it is the committee's fault for the lack of staff education. ..Maurice.

Thursday, April 22, 2010  

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