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Clinical Consultation

Requesting a Clinical Ethics Consultation

Who?

Ethics consultations may be requested by any member of the health care team. As a matter of courtesy, the attending physician of record is notified.

What?

Clinical ethics consultations are interventions by trained members of the Clinical Ethics Committee to help resolve an ethical dilemma or answer an ethical question that arises in the course of patient care. The consultation is purely advisory. Clinical Ethics Committee members and consultants have no authority to make patient care decisions. Patients and their insurers are not charged directly for ethics consultations.

The process depends on the complexity of the situation in question. Sometimes a simple phone call takes care of it. Other times a multidisciplinary team meeting involving all stakeholders is required. Still more cases are somewhere in between. Steps in the process may include steps such as:

  • Consultants review medical records and interview the patient, physicians, nurses, family members, surrogate decision makers, and other relevant parties.
  • They provide an analysis of the ethical issue and suggest means to resolve it. This may include a face-to-face meeting with all parties.
  • The primary consultant dictates a progress note with recommendations that is added to the patient's record.
  • The case is then presented to the full Clinical Ethics Committee at its next scheduled meeting and discussed.
  • Follow-up is often performed.

When & why?

Ethics consultations may be appropriate when a clinical-ethical dilemma arises in the course of patient care. The most common issues prompting clinical ethics consultations are:

  • Lack of consensus on the caregiver team
  • Conflict between caregivers and patient or surrogate decision-makers
  • Uncertainty about who should speak on behalf of a patient
  • Challenging situations that pit two ethical priorities against each other
  • Moral distress

Ethics consultations are not appropriate for primarily legal or financial questions, or for allegations of professional misconduct. The former questions can be addressed to Risk Management or General Counsel; the latter to the Code of Professional Conduct Advisory Panel.

How?

Real-time clinical ethics consultation can be obtained by contacting the on-call clinical ethicist. To reach the on-call consultant, please use the Amion call schedule online or call the DHMC operator at (603) 650-5000.

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