Clinical Ethics Consultation
Health care professionals, patients, and families can become involved in complex situations that may be confusing and call for extensive discussion of options and goals of care. CPMC’s ethics consultation service is here to assist you in these times. A multidisciplinary group, the consultation service is provided by bioethicists, physicians, nurses, social workers, chaplains, administrators and others.
What is an ethics consultation and why would one request one?
An ethics consultation is a process in which the Program in Medicine & Human Values the CPMC ethics committee help patients, families, doctors and other healthcare providers when they are faced with difficult ethical decisions. Trained consultants or a sub-committee of the ethics committee respond directly to any individual involved in a patient's care. The consultants or the sub-committee will make recommendations regarding the most ethically appropriate actions in each case. These recommendations are advisory only and the health care team is responsible for its own decisions.
You should consider asking for an ethics consultation when you perceive that there is an ethical problem in the care of a patient and the health care team has not been able to establish a resolution that is agreed upon by the patient and/or family (surrogate) and the health care team treating the patient.
You should consider asking for an ethics consultation even when patient care is not the issue if you believe that there is a lack of clarity about an ethics policy or concept that would benefit from education.
Some of the issues for which ethics consultation may be useful include:
- Advance directives
- Surrogate decision making
- The refusal of treatment
- Conflicts with caregivers
- Withholding or withdrawing treatment
- Do Not Resuscitate orders
- Other issues perceived as ethical problems
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How does one request a consultation?
An ethics consultation can be in initiated by either:
- Placing a call to the Medical Ethics Hotline. On the Pacific, California, and Davies campuses, and for all other outpatient facilities, the number is
(415) 600-3991. On the St. Luke's campus, the number is (415) 641-6737
- emailing us at firstname.lastname@example.org
Should you call the hotline, leave a detailed message that explains the nature of the situation and ethical problem with which you need consultation. Make sure you fully identify yourself and the patient and a method for which you can be contacted. Leave any special instructions as well. The hotline is monitored from 9:00 a.m. to 5:00 p.m. Monday through Friday. After hours and on weekends, if the situation is an emergency, the Medical Center’s Administrator-on-Call can be contacted for consultation by calling the hospital operator. If the situation is not emergent, please follow the normal procedure and the case will be reviewed the next business day. All information provided on the hotline is confidential.
Emails are monitored in the same manner as the hotline and all the same procedures apply.
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What happens next?
Once you have requested a consultation, someone from the Program will contact you. You may be asked for more information. The Program may decide to hold a formal ethics consultation. These bear directly on some aspect of patient care decision making because they may involve substantive discussions between medical ethics consultants and attending physicians and families. These result in recommendations on how to proceed and chart notes. The Program may also decide that an informal consultation is necessary, in which ethical issues related to patient care are raised and considered. These discussions function primarily to identify and clarify moral concerns voiced by you, your family, or your healthcare providers, and typically involve conversations between you, your family, medical ethics consultants, physicians, nurses, and other hospital personnel. Although primarily educational in nature, informal consultations may evolve into formal consultations.
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