00:01
So now I'd like to talk about health care,
ethics consultation.
00:04
There may be times in patient care when it's
helpful for either the patient, their family or
the members of the health care team to get an
additional perspective about how to handle a
challenging situation.
00:18
So health care ethics consultation is often a
service provided by many hospitals.
00:23
Again, it's available for the patients
themselves, for their families or their decision
makers, any of the clinicians and perhaps other
parties where there are these value laden
concerns that need to be resolved and, you
know, try to figure out how to best take care of
the patient. So the goal, when there is a
consultation, is to promote ethically sound
decision making, when there's either
uncertainty or conflict about a course of
action. This can be delivered either by a
single consultant.
00:55
There may be a team of consultants or an
interdisciplinary committee that meets, gathers
all the information, and then discusses things.
01:04
So what is the role of the ethics consultant?
Well, first of all, they're generally going to
have some amount of expertise in ethical theory
or thinking about clinical ethics.
01:15
And their role is to clarify the concerns of
whoever's asking for the consultation, whoever's
putting in that request to make sure that the
issues are clarified.
01:26
They're going to help facilitate communication
among all the key stakeholders.
01:30
They're really going to try to foster an
understanding of the clinical situation and what
are the issues that are at stake.
01:38
Their role as a consultant, especially as an
ethics consultant, is to then really clarify and
analyze what the ethical issues are.
01:44
There may be medical issues.
01:46
There may be, you know, decisions that need to
be made medically.
01:49
But the role of the ethics consultant is to
really focus on the ethical issues and then
ultimately provide some recommendations with
some justification for why they're making those
recommendations. So let me walk you through the
ethics consultation process.
02:04
So as I said, the first step is usually there's
a requester that reaches out to the ethics
consultant, and then the job of the ethics
consultant is to systematically gather
information so that requester, they're going to
question them as to what are the ethical issues,
Are there other concerns that that are
bothering that person, whether it's from the
patient perspective or from the team
perspective, perhaps they're going to then
review the medical record to really understand
what the clinical issues are, understand the
patient's medical condition, what the treatment
options are.
02:38
Perhaps a little bit about the patient
background.
02:41
You know, who they are as a person.
02:44
Next, there might be a search for any kind of
documents that reflect the patient's values and
or preferences.
02:50
So that might be previous clinical notes where
that's been documented.
02:54
Perhaps the patient has an advanced directive
where they've they've either named a surrogate
decision maker or perhaps have specified
particular wishes about if they were in in a
condition, how they would want treatments to be
done or not done.
03:08
There may be orders for life sustaining
treatment.
03:12
You'll hear about that in other lectures.
03:14
And you're going to look as an ethics consultant
for any of those those documents or evidence of
the patient's wishes.
03:22
The next step would be then to interview the
stakeholders.
03:25
So identify who are the important parties that
can speak to the issue at hand.
03:30
Obviously, often that's going to be the
patient, their family, other persons in that
patient's, in their in their life.
03:40
Members of the health care team.
03:42
Again, all of the clinical team members may
have a different role and a different
perspective about how to handle the case.
03:50
Often there's going to be a need to facilitate
a meeting between those stakeholders.
03:55
And really when you're gathering people
together, really encouraging that, make sure
that all voices are heard in that meeting so
that you really hear all of the perspectives.
04:05
Once all that information has been gathered,
then the role of the ethics consultant is to
deliberate about ethically permissible options.
04:13
So if this is a team of consultants, maybe
they're going to be talking with each other,
providing their rationale for why they would
make a particular recommendation.
04:21
If it's a single consultant, they're going to
think through all of the issues on their own.
04:25
They then provide those recommendations to the
patient, to the family members, to the team.
04:33
Hopefully that's done in person.
04:34
So there's a verbal communication so that if
there are questions right on the on the spot,
that those can be answered by the consultant.
04:42
It's also important for the consultant to
document this in the medical record.
04:46
So in the future, how they deliberated, how they
made their recommendations is known to future
providers and and to the patient as well.
04:56
And then it's up to the clinicians and the
patient again, working in the informed consent
process to decide whether they're going to
follow through on those recommendations.
05:05
So they would institute a plan, perhaps have an
opportunity to reevaluate how that plan is
working, maybe consult the ethics consultant if
they need to.
05:18
So just let me give you one example of where
this might happen.
05:21
Often we might see ethics consultations for
patients at the end of life.
05:26
So the American Medical Association, in their
code of medical ethics, talks about the need for
seeking consultation.
05:33
That could either be through an ethics
committee or an ethics consultant or any other
appropriate resource where there's a need for
ethics guidance.
05:42
And the three instances where they think about
this in the AMA code are, first of all, the
patient or surrogate.
05:49
And the health care team just cannot reach an
agreement about a decision to withhold or
withdraw life sustaining treatments.
05:56
The medical team might feel that it's
appropriate to discontinue a life sustaining
treatment. It's not achieving the ends that
were hoped for.
06:04
The patient or their family or their surrogate
might disagree with that decision.
06:09
So bringing in a consultant to hear about the
different issues and perspectives.
06:13
Second, there might be no surrogate available,
so maybe the patient lacks decision making
capacity. You need to have a decision maker.
06:22
You don't find anybody that can serve that role
and is willing to make decisions on behalf of
the patient. So there you have to either use
the consultant to then figure out who you seek
as a consultant, as a surrogate might need to
go in the United States.
06:38
We might go to court to seek a guardian to
speak on behalf of the patient.
06:43
So that's another place where the ethics
consultant can serve a role and help to speak to
the ethical issues at stake.
06:49
And then also, there may be the instances where
the physician really disagrees with the decision
by a patient or a surrogate.
06:57
They really feel that it clearly violates the
patient's previously expressed values, goals of
care or treatment preferences and does not seem
to be in the patient's medical interest.
07:07
They're the the health care team.
07:09
The physician is reaching out to the consultant
to say, I know this patient.
07:14
I know what they've expressed previously.
07:17
Their surrogate decision maker seems to be
making a decision that's that's counter to my
knowledge of the patient and their their values
and preferences.
07:24
So maybe the ethics consultant can help sort
out how to resolve that that dispute or that
conflict. So those are just a few examples of
where you might see the role of an ethics
consultant. Not all hospitals have these, but
often where they are available.
07:40
It can be an additional resource for the
clinicians and the patients and their families
to figure out how to best take care of the
patient.