CLINICAL ETHICS

Views regarding the training of ethics consultants: a survey of physicians caring for patients in ICU

Eric Chwang, David C Landy and Richard R Sharp

Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA

Correspondence to:
Correspondence to:
Professor R R Sharp
Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Room 310D, Houston, TX 77030, USA; rsharp{at}bcm.tmc.edu

Background: Despite the expansion of ethics consultation services, questions remain about the aims of clinical ethics consultation, its methods and the expertise of those who provide such services.

Objective: To describe physicians’ expectations regarding the training and skills necessary for ethics consultants to contribute effectively to the care of patients in intensive care unit (ICU).

Design: Mailed survey.

Participants: Physicians responsible for the care of at least 10 patients in ICU over a 6-month period at a 921-bed private teaching hospital with an established ethics consultation service. 69 of 92 (75%) eligible physicians responded.

Measurements: Importance of specialised knowledge and skills for ethics consultants contributing to the care of patients in ICU; need for advanced disciplinary training; expectations regarding formal-training programmes for ethics consultants.

Results: Expertise in ethics was described most often as important for ethics consultants taking part in the care of patients in ICU, compared with expertise in law (p<0.03), religious traditions (p<0.001), medicine (p<0.001) and conflict-mediation techniques (p<0.001). When asked about the formal training consultants should possess, however, physicians involved in the care of patients in ICU most often identified advanced medical training as important.

Conclusions: Although many physicians caring for patients in ICU believe ethics consultants must possess non-medical expertise in ethics and law if they are to contribute effectively to patient care, these physicians place a very high value on medical training as well, suggesting a "medicine plus one" view of the training of an ideal ethics consultant. As ethics consultation services expand, clear expectations regarding the training of ethics consultants should be established.

Abbreviations: ICU, intensive care unit; TMH, The Methodist Hospital

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