Who Are the Ethicists and When Are Ethical Consultations Appropriate?

It appears that in the real world as opposed to the insular world of academia, those on the ethics firing line are the ones doing the real work of medicine – i.e., the physicians and nurses. Bioethics is best done by those who encounter these real-life issues on a regular basis, out in the world. Academics can talk and write at length and at their leisure, but there is no substitute for actual experience.

Of course, a well-rounded ethics consultation team could include an attorney familiar with ethical principles and conflicts, as well as community leaders. A philosopher might be valuable is she has experience with real people. And a theologian would be valuable is she is a skilled communicator, and likewise familiar with ethical principles and conflicts.

An ethics consultation can be called-in by a hospital or health care facility administrator, physicians and nurses in charge of the patient, the patient, and any of the patient’s immediate family. The patient’s attorney, also, could call-in an ethics consult.

However, it’s not appropriate or even safe to pull the Emergency Cord on a speeding train when you discover you left your car keys at home. It’s important for an ethics consultation request to be based on substantive issues or needs, but some individuals might request a consult merely because they’re angry or frustrated. In such circumstances a skilled ethics consultant could calm things down quickly and get everyone back to the business of caring for the patient.

Concerns regarding autonomy and respect for persons represent appropriate criteria for an ethics consult. When a competent elderly person refuses artificial nutrition, in opposition to physicians’ orders, questions of autonomy are raised. A parent requesting removal of life support from a nonresponsive child – after a brief period of therapy – likewise raises questions of autonomy, as well as other ethical issues.

Additional criteria relate to questions of beneficence/nonmaleficence. A 65-year-old diabetic female refuses an above-the-knee amputation, raising questions of both autonomy and beneficence. The wife of a comatose motorcycle accident victim wants his respirator turned off. He has a C2/C3 fracture and is quadriplegic. She “knows he would not want to live like this” – these are questions of autonomy and beneficence.

Distributive justice is another key area of ethical concern. Who gets to receive and/or utilize scarce medical resources? A serious highway accident results in 20 victims, five of whom have lost a lot of blood by the time the EMTs arrive. Two of the injured require two units each of AB negative blood. The med tech team only has two units on board. An ethics consult team might be called-in after the fact to review the EMTs decision-making and protocols.

Ethics consultations may be called-in merely for low-level conflict resolution – i.e., two sides butting heads. It seems such conflicts could be resolved quickly without wasting precious resources.

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