Community hospital ethics consultation: Evaluation and comparison with a University Hospital Service

Abstract

background: Ethics consultants may improve patient care by responding to physician requests for assistance with problems they identify as ethical issues.

objective: To examine three aspects of ethics consultation: the clinical questions asked; the helpfulness of the consultation to requesting physicians; and the differences between consultations performed at a community teaching hospital and those performed at a university hospital.

settings: A community teaching hospital and a university teaching hospital.

subjects: Physicians who formally requested ethics consultations in both hospitals and the patients for whom they requested them.

methods: Over 2 years (January 1, 1988, to December 31, 1989), we prospectively evaluated a newly established clinical ethics consultation service in a community teaching hospital using confidentially completed, pretested, structured questionnaires, and compared our data with previously reported university hospital data.

results: During the 2-year study, 104 consultation requests were received from 68 physicians in eight departments. Requesters most often requested consultation about deciding to forego life-sustaining treatment (74%), resolving disagreements (46%), and assessing patient competence (30%). Requesters found the consultation “very helpful” or “helpful” in one or more aspects of patient care in 86% of cases, or in one or more aspects of physician education in 86% of cases. These data are similar to university hospital data.

conclusion: A trained physician-ethicist can provide helpful, clinically acceptable assistance in patient care and physician education in both university and community teaching hospitals.