Appendix A
Purpose
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.
Definitions
- Lead Consultant: a member of the ECS designated to take and respond to calls
- Special Consultant: a member of the ECS with special competence in a particular area
- Consultation: a formal process conducted by the lead consultant that includes all involved parties as deemed appropriate (for more about consultations, see below)
- Conversation: 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)
Policy
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.
Procedures
To follow policy, the lead consultant shall:
- Gather relevant data (through discussions with involved parties, examinations of medical records or other relevant documents, etc.)
- Ensure the opportunity to have dialogue with involved parties
- Clarify relevant concepts (e.g. confidentiality, privacy, informed consent, best interest)
- Clarify related issues (e.g., implications of societal values, law, ethics, and institutional policy)
- Help to identify and build a range of morally acceptable options within the context
- Assist involved individuals in clarifying their own values
Consultations
- Patients, families, 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 group
- discussing the case with other members of the consult service
- discussing the matter with appropriate interested parties (e.g. chaplaincy, risk management, legal counsel)
- gathering any other information or opinions thought to be helpful, being careful at all times to respect the privacy of the patient
- Strict 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.
- Following the 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 consultant shall:
- Set the length of the meeting, the issues to be discussed and the goals of the meeting in the beginning
- Assure that the appropriate decision-makers are present
- Explain the purpose and parameters of the meeting.
- Emphasize the 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, education about 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.
Conversations
- 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.