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Original research
Taking the burden off: a study of the quality of ethics consultation in the time of COVID-19
  1. Lulia Kana1,
  2. Andrew Shuman2,3,
  3. Raymond De Vries2,
  4. Janice Firn2,4
  1. 1 University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3 Otolaryngology—Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
  4. 4 Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Janice Firn, Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI 48109, USA; jfirn{at}med.umich.edu

Abstract

Background The quality of ethics consults is notoriously difficult to measure. Survey-based assessments cannot capture nuances of consultations. To address this gap, we conducted interviews with health professionals who requested ethics consults during the initial phase of the COVID-19 pandemic.

Method Healthcare professionals requesting ethics consultation between March 2020 and May 2020 at a tertiary academic medical centre were eligible to participate. We asked participants to comment on the consults they called and thematically analysed responses to identify features associated with optimal quality consultations.

Results Of 14 healthcare providers, 8 (57%) were women and professions were as follows: 11 (79%) medical doctors, 1 (7%) social worker, 1 (7%) physician assistant and 1 (7%) nurse practitioner. Two aspects of quality emerged: satisfaction and value. Themes within the domain of satisfaction included: responsiveness of the ethics consultant, willingness to consult, institutional role of the ethics service and identifying areas for improvement. When describing value, respondents spoke of the intrapersonal and interpersonal worth of consultation.

Conclusion Participants were generally satisfied with ethics consultation services, similar to opinions of those found in pre-COVID-19 survey studies. Our qualitative approach allowed for a richer exploration of the value of ethics consultation during the pandemic and has implications for ethics consultation services more broadly. Ethics consultation—emphasising both the process and outcome—created valuable moral spaces, promoting thoughtful and ethical responses to dilemmas in patient care. Future assessments should incorporate patient and family/surrogate perspectives and explore the domain of education as an additional quality measure.

  • ethics committees/consultation
  • clinical ethics
  • quality of healthcare

Data availability statement

No data are available.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/medethics-2020-107037

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    Data availability statement

    No data are available.

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    Footnotes

    • Twitter @janicefirn

    • Contributors LK contributed to study conception and design, data collection and interpretation, drafted and revised the manuscript for critically important intellectual content, provided approval for the final manuscript as submitted and agrees to be accountable for all aspects of the work. AS contributed to study conception and design, data collection and interpretation, revised the manuscript for critically important intellectual content, provided approval for the final manuscript as submitted and agrees to be accountable for all aspects of the work. RDV contributed to study conception and design and data interpretation, revised the manuscript for critically important intellectual content, provided approval for the final manuscript as submitted and agrees to be accountable for all aspects of the work. JF contributed to study conception and design and data interpretation, revised the manuscript for critically important intellectual content, provided approval for the final manuscript as submitted and agrees to be accountable for all aspects of the work.

    • Funding This work was supported by the University of Michigan Center for Bioethics and Social Sciences Internal Pilot Project Grant.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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