Ethics Consultations Curbside and Elsewhere

George Flangan, DMin, MA

Program Associate

Center for Practical Bioethics

Physicians in private practice settings, and often in hospital settings as well, do not go far to seek consultation for their ethical concerns. It is typical, especially in small communities where there are few physicians and no bioethicists, that a phone call or a hallway chat with a colleague, usually in the same practice, is deemed sufficient to make an ethically sound decision.

Do they know the right questions to ask?

The Center for Practical Bioethics has long recommended interdisciplinary ethics consultation teams/committees because the conversation allows a diversity of perspectives. Among physicians who practice together, as with most professional groups, there develops a culture of practice that may effectively limit the questions they ask about treatment decisions.

It’s as true in healthcare ethics as it is in any part of life: If I have an ethical concern or, at least, some uncertainty about a treatment, I will do best to include in the consultation someone who is willing to tell me I am, simply, wrongheaded, rather than merely helping me justify an action I have already decided I want to take.

Link: Consultations on ethics are not limited to the curbside, American Medical News, September 20, 2010

Balancing Outcomes and Moral Values

Rosemary Flanigan

June 17, 2010

John Lantos reviewed a book for the latest Hastings Center Report (Vicki Forman. This Lovely Life. Mariner Books 2009) and I thought of our case consults.

The author delivered twins after just twenty-three weeks of gestation. One twin dies. Eight years later, after years of challenges, the other severely disabled twin also dies of acute intestinal blockage.

She tells of the refusal of the neonatologists to write a DNR order (John gnashes his teeth!), of the ongoing daily decisions, of her eventual embrace of the remaining child and his multiple anomalies. So when she is asked, “Knowing what you know now, would you still demand that the twins not be resuscitated?” she answers, “I don’t know.”

We ask questions like that in our consults—and how can we expect others to respond as if the there were no intervening mass of fear, grief, compassion and love?

I shall die urging people to be reflective and to do ethical analyses but we must also admit (as in the Truog case) that it is not an exercise of balancing outcomes or justifying placing one moral value above another. Though these steps are important, sometimes they are not sufficient.

ANY COMMENTS???

Conflict = Ethics Consult

Rosemary Flanigan

April 29, 2010

I’ve told countless ethics committees: “When will you have a consult? When there’s a conflict.”

But maybe there is more to see here: Maybe the moral distress felt by families who are having too much information thrown to them, are being asked questions to which they have no answers, are being deluged by concerns over which they have no control, need to have the services of an ethics committee made available to them.

Perhaps they don’t even see what they are facing as conflictual; but the sensitive physician who offers to participate in such a consult might provide great benefit to the family and perhaps even to him/herself!

What do you think?

Roaming for Ethics Consults

Rosemary Flanigan

April 28, 2010

Some hospitals have people who "roam" about the hospital looking for ethical issues and/or pain sufferers.

Last week when I was talking to a group of nurses and one complained that she often has to do inhumane treatment on a child without being able to talk to the physicians who were ordering it, I reached back into my life as an academic and wondered if hospitals couldn’t profit from a DEAN!!

We always had recourse to a dean who could whip recalcitrant faculty into some sort of order. I think well-functioning ethics committees could serve this purpose, IF issues are brought to them.

What do you think?