Ethics Consultation Policy
An Ethics Consultation is a process by which trained consultants or an Ethics Consultation Sub-Committee of the Ethics Committee responds to requests for help to resolve ethical conflicts, issues, or questions involving patient care. An Ethics Consultation is advisory. Patients, family members, and health care providers remain responsible for their own decisions. Clarification of the ethically accepted course of action can help the health care providers and patients navigate difficult clinical circumstances.
The Ethics Consultation Service
The Ethics Consultation Service is staffed by clinical bioethicists who are members of the Department of Bioethics. Typically, the Ethics Consultation Service is able to respond quickly to requests for assistance.
The Ethics Consultation Service is primarily intended as a resource when patients, family members or health professionals may feel that they have reached the limits of their own personal or professional ability to address ethical questions.
The Cleveland Clinic Foundation offers this advisory service free to patients, family members and health care providers. The patient and anyone involved in caring for that patient can request an Ethics Consultation without fear of intimidation or reprisal. All discussions are confidential.
Ethics Consultation Sub-Committee
Some questions or issues necessitate the use of an ad hoc sub-committee of the CCF Ethics Committee. This sub-committee is convened for any of the following reasons:
- The Chairman of the Ethics Committee (or designee) believes that the issues are sufficiently complex that a team composed of members of the Ethics Committee would be beneficial to advise about the issue.
- The person requesting the Ethics Consultation believes that the issues are sufficiently complex that advice by members of the Ethics Committee would be beneficial.
- Ethics Committee or CCF policy requires involvement of members of the Ethics Consultation.
- External agencies request a formal analysis of or recommendation about a case.
When Should an Ethics Consultation be Requested?
An Ethics Consultation may be requested when an ethical problem or question involving patient care is not being satisfactorily addressed or resolved for all concerned. The Ethics Consultation is designed to support, not to replace normal lines of communication about ethically troubling situations. Requests for help from the Ethics Consultation Service are encouraged when:
- A patient, a family member or health care provider wants to "talk through" important ethical dimensions of the patient's care;
- Efforts by the patient, family and professional staff to resolve a problem have reached an impasse;
- There is serious ethical disagreement among health care providers or within the patient/family relationship;
- The case is ethically unusual, unprecedented or very complex;
- In decisions about life-sustaining medical treatment for patients unable to decide for themselves
- In situations when communication or cooperation with the patient's surrogate decision maker is compromised; or,
- A patient, family member or health care provider needs help in facing an ethically significant decision has to be made.
What Are Some Common Ethical Problems?
In general, an ethical problem exists when it is not clear what is the ethically sound action or course of action or when people disagree about what is best for a patient.
The following are some examples of ethical problems that can arise in the hospital:
- What should a patient or surrogate do when he/she cannot understand what caregivers are saying, but tests and treatments continue anyway?
- Who should make health care decisions when patients are unable to communicate or decide for themselves?
- What should family members or caregivers do when they strongly disagree or are very uncertain about what is best for the patient?
- When should life-prolonging treatments be started, continued or stopped?
- What should family members and caregivers do when a patient refuses treatment that promises to be medically beneficial?
These and other ethical questions and concerns may develop to the point where conflict and serious disagreement results. Health care providers should rely on their education, experience and good judgment to prevent such escalation of disagreement. Discussing such situations with the Ethics Consultation Service might prove helpful before a true impasse is reached.
How is an Ethics Consultation Requested?
Patients and family members can directly request an Ethics Consultation by calling the hospital operator and asking for the Ethics Consultation Service. They can also tell their nurse or health care provider that they want an Ethics Consultation.
Staff made aware of a patient's or family's desire for an Ethics Consultation shall convey the request to the Ethics Consultation Service.
During work hours, the Ethics Consultation Service can be reached by calling the Department of Bioethics at 4-8270. All other times use Pager 22512.
Physicians or House Staff may convey their request for an Ethics Consultation personally by telephone or by written orders in a patient's medical record, which shall be conveyed by Nursing Staff to the Ethics Consultation Service.
Nursing Staff or other employees may request an Ethics Consultation directly or through their supervisor or manager who will initiate the consultation request.
The Ethics Consultant will notify the Attending Physician or their designee of the request for an Ethics Consultation.