The Ethics Consultation Service (ECS) is
provided by the Medical Ethics Advisory Committee to assist patients, families,
surrogates, health care providers or other parties in addressing uncertainty or
conflict regarding ethical issues that emerge in healthcare.
member of the ECS designated to take and respond to calls
a member of the ECS
with special competence in a particular area
a formal process conducted by
the lead consultant that includes all involved parties as deemed
appropriate (for more about consultations, see below)
a verbal exchange of ideas and opinions regarding a problem or area of
interest that does not meet the requirements of or qualify as a
consultation (for more about ethics conversations, see below)
An ethics consultant will be on call to respond in a timely manner to requests
for assistance in addressing an ethical issue involving patient care.
surrogates, health care providers, and other involved parties may request an
ethical consult without fear of reprisal.
If an ethics
consultation request is deemed appropriate, the lead consultant will gather
information and proceed with any or all of the following measures:
reviewing the patient's medical record
interviewing involved parties, either individually or in groups
discussing the case with other members of the consult service
discussing the matter with appropriate interested parties (e.g.
chaplaincy, risk management,
gathering any other information or opinions thought to be helpful, being careful at all
times to respect the privacy of the patient
attention to confidentiality will be maintained during the entire process
Any member of the
consult service should decline to participate in a consultation should a
conflict of interest arise. If the consultation involves a patient
within one of the member's area of patient responsibility, that member
should decline, to avoid any appearance of conflict.
gathering of information, a consultation meeting of most or
all persons involved may be indicated, especially if there is a difference
of opinion about ethically acceptable options. A good-faith effort will be
made to involve all parties.
The meeting shall proceed along the following guidelines. The lead
set the length
of the meeting, the issues to be discussed and the
goals of the meeting in the beginning.
the appropriate decision-makers are present.
purpose and parameters of the meeting.
goals of maintaining confidentiality, and
allow time for
each person present to express his or her thoughts concerning the case.
The consultation meeting will focus on the clarification of options,
relevant ethical issues, and mediation as necessary.
The consult shall be documented by
the consultation lead consultant in the patient's record.
Evaluation of each consultation
will occur at regularly scheduled consultation subcommittee meetings.
Patients, families, surrogates,
health care providers, and other involved parties may request an ethics
conversation without fear of reprisal.
An ethics consultant will
be on call to receive the request and respond in a timely manner.
An ethics conversation is always
appropriate. This conversation is often a prelude to a full consultation
but can simply be an informal discussion. Any member of the Ethics
Consultation Service can be approached for this "conversation."
In the conversation setting, only
the individuals involved in the "conversation" will be known. All
identifying information pertaining to those not present will be kept
confidential by the person requesting the conversation.
If a conflict of interest is
identified by any party to the conversation, he/she will withdraw at
that time and if appropriate suggest another member (or members) of the
service to proceed with the conversation.
The conversation is informal and
has no specific protocol guidelines.
Moral advice as to particular
outcome will be avoided. The conversation is seen as more heavily
focused on education about relevant ethical issues than mediation.
Since most participants are not
identified, documentation in the medical record would not be possible.
However, all conversations are reported at the next scheduled meeting of
the service and subject to critique. Strict confidentiality will
continue to be maintained. A summary of this educational discussion will
be recorded in the subcommittee minutes.