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What triggers requests for ethics consultations?
  1. Gordon DuVal,
  2. Leah Sartorius,
  3. Brian Clarridge,
  4. Gary Gensler,
  5. Marion Danis
  1. University of Toronto, National Institutes of Health, Bethesda, Maryland, University of Massachusetts, Boston, EMMES Corporation, Potomac, Maryland and National Institutes of Health, respectively


    Objectives—While clinical practice is complicated by many ethical dilemmas, clinicians do not often request ethics consultations. We therefore investigated what triggers clinicians' requests for ethics consultation.

    Design—Cross-sectional telephone survey.

    Setting—Internal medicine practices throughout the United States.

    Participants—Randomly selected physicians practising in internal medicine, oncology and critical care.

    Main measurements—Socio-demographic characteristics, training in medicine and ethics, and practice characteristics; types of ethical problems that prompt requests for consultation, and factors triggering consultation requests.

    Results—One hundred and ninety of 344 responding physicians (55%) reported requesting ethics consultations. Physicians most commonly reported requesting ethics consultations for ethical dilemmas related to end-of-life decision making, patient autonomy issues, and conflict. The most common triggers that led to consultation requests were: 1) wanting help resolving a conflict; 2) wanting assistance interacting with a difficult family, patient, or surrogate; 3) wanting help making a decision or planning care, and 4) emotional triggers. Physicians who were ethnically in the minority, practised in communities under 500,000 population, or who were trained in the US were more likely to request consultations prompted by conflict.

    Conclusions—Conflicts and other emotionally charged concerns trigger consultation requests more commonly than other cognitively based concerns. Ethicists need to be prepared to mediate conflicts and handle sometimes difficult emotional situations when consulting. The data suggest that ethics consultants might serve clinicians well by consulting on a more proactive basis to avoid conflicts and by educating clinicians to develop mediation skills.

    • Ethics consultation
    • resolution of ethical problems
    • ethical conflicts

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    • Gordon DuVal, SJD, is Bioethicist at the Centre for Addiction and Mental Health and University of Toronto, Joint Centre for Bioethics, Toronto, Canada. Leah Sartorius is Research Assistant in the Department of Clinical Bioethics, the National Institutes of Health, Bethesda, Maryland, USA. Brian Clarridge, PhD, is a Senior Research Fellow, Centre for Survey Research, University of Massachusetts, USA. Gary Gensler, MA, is a Statistician at the EMMES Corporation, Potomac, Maryland, USA. Marion Danis, MD, is Head of the Section on Ethics and Health Policy in the Department of Clinical Bioethics, Clinical Centre, National Institutes of Health, Bethesda, Maryland, USA.

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