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Clinical Ethics Consultation

What is an ethics consultation and why would one request one?
How does one request a consultation?
What happens next?

What is an ethics consultation and why would one request one?

The Program in Medicine & Human Values is available to help patients, families, doctors and other healthcare providers when they are faced with difficult ethical decisions.

Our mission is to coordinate the medical care delivered to a particular patient with the values and life goals of that patient.

Here's an example of a situation in which ethics consultation is needed:

Your father has just sold the small manufacturing company that he founded and ran for fifty years and is enjoying his first year of real retirement. He is a spirited and vivacious man of seventy-five. But all of a sudden, his plans are interrupted: your father suffers a serious stroke. He is hospitalized and is in intensive care for two weeks, dependent on a respirator and unable to communicate. Doctors tell you that, while he might survive, he will probably have permanent physical and mental damage. Your mother, you and your siblings are left to decide what to do to care for your father.

You, your sister and one of your brothers (the other is in Europe) have dinner at your mother’s. It is clear that there is little agreement about what to do. Mom is very distressed and quite uncertain. You strongly believe that Dad would not want to live disabled. Your sister only expresses hope in full recovery. Your brother firmly states that we have no right to make such a life and death decision: this situation simply has to run its course, he says. None of you is very sure what the course might be, nor are you clear about who has the authority to make a decision. Your mother says she will not be the one to end Dad’s life. Your eldest brother will return from his trip tomorrow.

Because of advances in technology, health care professionals, patients, and families can become involved in ethically challenging situations. These complex situations may be confusing for patients and families, and call for extensive discussion of options, as well as an overview of how others have resolved similar ethical dilemmas.

The best initial approach to an ethical conflict (a conflict in values) is a discussion that can include patients, family members, chaplains, nurses, physicians and other involved health care professionals. These discussions may be organized as a patient care conference.

Sometimes the additional assistance of an ethics consultation may be helpful. California Pacific Medical Center’s Program in Medicine & Human Values’ Consultation Service is a multidisciplinary group. The consultation service is provided by physicians, nurses, social workers, chaplains, administrators and others.

Some of the problems for which ethics consultation may be requested 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

How does one request a consultation?

An ethics consultation can be in initiated by either:

Placing a call to the Medical Ethics Hotline at (415) 600-3991. When you call, 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.

You can also submit a request for consultation via email. These are monitored in the same manner as the hotline and all the same procedures apply. Email us at ethics@sutterhealth.org.

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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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