Clinical Ethics Consultations
What is a Clinical Ethics Consultation?
Healthcare raises complex and often troubling issues for patients, families and care professionals. Sometimes, ethical principles and obligations are in conflict, which creates ethical dilemmas. For example, respecting a patient’s right to make care decisions can conflict with the obligation to promote best interest when the patient makes a decision that puts him at unnecessary risk. Likewise, the obligation to provide care to patients who need it may be in conflict with the obligation to be responsible stewards of healthcare resources. The obligation to protect patient confidentiality may be in conflict with the obligation to protect third parties at risk.
Because these matters have profound and lasting consequences, they can create uncertainty about the most appropriate course of action. The HackensackUMC Clinical Ethics Consultation Service is available to meet with staff, patients and families or other surrogates to help identify, clarify and resolve these ethical dilemmas.
What kinds of issues do clinical ethics consultations address?
Some of the issues most commonly considered in clinical ethics consultations include:
- How and by whom is a patient’s ability to make healthcare decisions evaluated?
- Who should make healthcare decisions for patients who cannot decide for themselves or communicate their wishes?
- Why are advance directives important in the healthcare setting and how are they used?
- What should happen if the patient or family rejects recommended treatments or care plans?
- What should happen if the healthcare agent’s decisions appear to conflict with the patient’s advance directive?
- What should happen if there is uncertainty or disagreement among the patient, family and/or care team about what is best for the patient?
- What should happen if the family insists that the patient not be given clinical information or included in care decisions?
- What should happen if the care team’s treatment recommendations conflict with the patient’s ethical, cultural or religious beliefs or traditions?
- What should happen when confidential patient information places a third person at risk?
- What should happen if the patient or family requests treatment that care professionals consider ineffective, inappropriate or likely to place the patient at unnecessary risk?
- When should life-prolonging measures, such as feeding tubes or ventilators, be started, continued or stopped?
- What should happen if comfort measures at the end of life seem to risk hastening a patient’s death?
- How can a bioethics consultation be requested?
Anyone involved in patient care—clinical professional, patient, family, healthcare agent or other surrogate—with an ethics concern can directly access the HackensackUMC Clinical Ethics Consultation Service. Clinical ethics consultations can be requested by contacting the Director of Bioethics at 551-996-4179, Monday through Friday, from 8:00 am to 4:30 pm. During evening and weekend hours, consultation requests will be directed to the Assistant Head Nurse on call through the operator.
Requests for bioethics consultation will be responded to within one working day and immediately in cases of emergencies. The case and the medical record will be reviewed and a conference will be convened with the patient’s care team, the patient and/or family or other surrogate and, when appropriate, selected members of the Biomedical Ethics Committee. On occasion, a case may also be reviewed at a full meeting of the Biomedical Ethics Committee. A summary of the consultation and recommendations will be documented in the patient’s medical record and follow-up will continue as long as the patient is in the hospital.