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Should ethics consultants help clinicians face scarcity in their practice?
  1. S A Hurst1,
  2. S Reiter-Theil2,
  3. A-M Slowther3,
  4. R Pegoraro4,
  5. R Forde5,
  6. M Danis6
  1. 1
    Institute for Biomedical Ethics, University of Geneva Medical School, Geneva, Switzerland
  2. 2
    Institute for Applied Ethics and Medical Ethics, University of Basel, Basel, Switzerland
  3. 3
    The Ethox Centre, Oxford University, Headington, UK
  4. 4
    Fondazione Lanza, Padova, Italy
  5. 5
    The Research Institute, Norwegian Medical Association and University of Oslo, Oslo, Norway
  6. 6
    Department of Clinical Bioethics, National Institutes of Health, Bethesda, MD, USA
  1. Dr M Danis, Department of Clinical Bioethics, Building 10, room 1C118, National Institutes of Health, Bethesda, MD 20892; mdanis{at}


In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them.

  • clinical ethics
  • ethics consultation
  • physicians
  • healthcare rationing
  • health resources

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  • Funding: This work was funded by the Department of Clinical Bioethics at the National Institutes of Health, and was conducted while SAH was a fellow at this Department. SAH was funded in part by the University Hospitals of Geneva, by the Oltramare Foundation, by the Centre Lémanique d’Ethique, and by the Swiss National Science Foundation.

  • Competing interests: None.

  • Ethics approval: Approval was given by the IRB of the National Institute of Child Health and Development at the US National Institutes of Health, and by the Trent Multi-Centre Research Ethics Committee in the UK. This study was examined and designated exempt from ethics committee review by IRBs in Norway, Italy, and Switzerland.

  • This article is based on an earlier version to be published in German,51 with the authorisation of the editors. The views expressed here are the authors’ own, and do not reflect the position of the National Institutes of Health, of the Public Health Service, or of the Department of Health and Human Services. Also, they are not necessarily those of the University Hospitals of Geneva, the Oltramare Foundation or the Centre Lémanique d’Ethique.