Evaluating an Ethics Consult

The most widely recognized model of clinical ethics case consultation is sometimes said to be an “ethics facilitation approach” That is, ethics consultants seek to resolve conflict in the case by facilitating discussion and the formulation of a plan that respects the values of the parties to the case and allows them to go forward with a mutually agreed-upon plan for the good of the patient. That is, the ethics consultant seeks to resolve conflict through consensus building. Facilitation must be qualified by being within ethically acceptable parameters. So, although an array of solutions may be acceptable, those that ignore such matters as established patient rights cannot be the outcome of a good ethics consultation. (See Task Force on Standards for Bioethics Consultation, Core Competencies for Health Care Ethics Consultation, The Report of the American Society for Bioethics and Humanities, 1998. http://www.asbh.org/resources/publications/index.htm )

The video provided on this site is not meant as a “model” consult. Rather, it is a record of a training exercise shot “cold.” Thus, you can evaluate the consult and rate how he did. Here are the dimensions on which you might rate the consultant’s work.

I. Prelude Video
(This is the first video in which the consultant, Jacque Jones, meets the two physicians and tells them what they might expect). In advance of a consultation, an ethics consultant must gather the facts and prepare any health-care team members for participation in the conference.

Q1: Does the ethics consultant do an adequate job of gathering the facts of he case from the two physicians? What kinds of things must the ethics consultant gather in advance of facilitating a conference?

Q2: Does the ethics consultant give the two physicians an adequate idea what they might expect from an ethics case consultation, in general, and in this case, in particular?

II. The Case Conference
(This is the second video in which the ethics consultant, the patient’s daughter—Bridget Coughlan, the patient’s consulting neurologist, and the attending physician, have an ethics case discussion.)

Q3: Does the ethics consultant do an adequate job of introducing himself and explaining what he does or what the goal of the conference is? Should he have said anything else?

Q4: Does the case conference result in the patient’s surrogate decision maker, Bridget Coughlan, understanding the medical facts of the case adequately? 

Q5: Does the case conference result in the patient’s attending physician understanding the patient’s values and wishes adequately? Does he adequately understand the surrogate decision maker’s understanding of the situation?

Q6: Does the ethics consultant do a reasonable job of “supporting” the surrogate decision maker through the conference? That is, does the consultant reinforce the notions that the surrogate’s understanding of the case is welcome in the discussion and that the patient’s legitimate rights will be respected?

Q7: Does the conference “flow” well or should the consultant have redirected it at points? If so, please be specific regarding when.

Q8: Does the consultant help to summarize and delineate the acceptable options? Is it clear what will happen next and how matters will proceed?

Q9: Are the options highlighted within ethically acceptable norms?