Report of 255 Clinical Ethics Consultations and Review of the Literature

doi:10.4065/82.6.686

Mayo Clinic Proceedings

Volume 82, Issue 6, June 2007, Pages 686-691

https://doi.org/10.4065/82.6.686 Get rights and content

OBJECTIVE

To review clinical ethics consultations at a tertiary care academic medical center.

METHODS

We retrospectively reviewed all ethics consultations (and associated patient medical records) conducted at the Mayo Clinic in Rochester, Minn, between April 6, 1995, and December 31, 2005.

RESULTS

Of the 255 consultations, 101 (40%) reviewed intensive care unit care, 103 (40%) involved patients who died during hospitalization, and 174 (68%) were requested by physicians. The most common primary diagnoses of the patients involved were malignancy (18%, n=47), neurologic disease (18%, n=47), and cardiovascular disease (17%, n=43). Most cases involved multiple issues: patient competency and decision-making capacity (82%, n=208), staff member disagreement with care plans (76%, n=195), end-of-life and quality-of-life issues (60%, n=154), and goals of care and futility (54%, n=138). Withholding or withdrawing measures was the focus of 132 (52%) of the consultations. We also identified previously published reports of ethics consultations and compared the findings of those reports with ours.

CONCLUSIONS

Despite advances in medicine, the nature of ethical dilemmas remains relatively unchanged. Issues of communication, family conflict, and futility continue to give rise to ethical quandaries.

Section snippets

Case Identification and Evaluation

Of the ethics consultations performed between April 6, 1995, and December 31, 2005, at the Mayo Clinic in Rochester, Minn, we included only those cases for which we could identify an ethical dilemma; identify the person requesting the consultation and the MCECS consultant engaged in data gathering and initial review of the case; document a consultation involving the patient, staff member, and ethics consultant; and identify recommendations made by the MCECS. Data were abstracted from completed

RESULTS

A total of 255 consultations involving 246 patients met the case identification criteria. Each consultation was evaluated as a discrete event. Nine patients had an ethics consultation on 2 separate occasions. Of these, 7 had more than one consultation during the same episode of care, either because requests were made by different parties or on different occasions or because separate ethical dilemmas were involved. The other 2 patients had consultations during episodes of care separated by many

DISCUSSION

The characteristics of our series and those of the previously reported series3, 4, 5, 6, 7, 8, 9, 10, 11 are listed in Table 3. To our knowledge, ours is the largest series to date. Furthermore, whereas most of the earlier reports generally encompass a 1- to 2-year period,3, 5, 7, 10, 11 ours covered an 11-year period. The MCECS conducted a mean of 2.1 consultations per month; this rate was lower than 5 of the prior series3, 5, 7, 10, 11 and greater than 4.4, 6, 8, 9

In our series, the patients

CONCLUSIONS

Despite recent advances in medical science and practice, the types of clinical ethical dilemmas that result in ethics consultation remain relatively unchanged. Issues of communication, family conflict, and futility continue to be major ethical quandaries, even though best efforts are made to educate patient care professionals. Clinicians should educate patients and families about advance care planning before ethical dilemmas arise.

REFERENCES (14)

J La Puma et al.
Community hospital ethics consultation: evaluation and comparison with a university hospital service
Am J Med
(1992)
Joint Commission on Accreditation of Healthcare Organizations
Comprehensive Accreditation Manual for Hospitals: The Official Handbook: 2006 CAMH
(2006)
AR Jonsen et al.
Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine
(2002)
WS Andereck
Development of a hospital ethics committee: lessons from five years of case consultations
Camb Q Healthc Ethics
(1992)
RD Orr et al.
Effectiveness of an ethics consultation service
J Fam Pract
(1993)
T Schenkenberg
Salt Lake City VA Medical Center's first 150 ethics committee case consultations: what we have learned (so far)
HEC Forum
(1997)
DB Waisel et al.
Activities of an ethics consultation service in a tertiary military medical center
Mil Med
(2000)

There are more references available in the full text version of this article.

Cited by (90)

A team-based early action protocol to address ethical concerns in the intensive care unit
2020, American Journal of Critical Care
Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety.
To investigate the effectiveness of a proactive, team-based ethics protocol used routinely to discuss ethics-related concerns, goals of care, and additional supports for patients and families.
In a pre-post intervention study in 6 intensive care units (ICUs) at 3 academic medical centers, the electronic medical records of 1649 patients representing 1712 ICU admissions were studied. Number and timing of family conferences, code discussions with the patient or surrogate, and ethics consultations; palliative care, social work, and chaplain referrals; and ICU length of stay were measured. Preintervention outcomes were compared with outcomes 3 and 6 months after the intervention via multivariate logistic regression controlled for patient variables.
The odds of receiving a family conference and a chaplain visit were significantly higher after the intervention than at baseline. The number of palliative care consultations and code discussions increased slightly at 3 and 6 months. Social work consultations increased only at 6 months. Ethics consultations increased at both postintervention time points. Length of ICU stay did not change.
When health care teams were encouraged to communicate routinely about goals of care, more patients received needed support and communication barriers were reduced.
Characterization of patients requiring inpatient hospital ethics consults- A single center study
2024, PLoS ONE
‘Sit down and thrash it out’: opportunities for expanding ethics consultation during conflict resolution in long-term care*
2024, New Bioethics
Psychiatric Hospital Ethics Committee Discussions Over a Span of Nearly Three Decades
2023, HEC Forum
Pragmatic Judgments in Direct Patient Care: Moral Theory at the Beginning of Clinical Ethics Consultation
2023, Pragmatic Judgments in Direct Patient Care: Moral Theory at the Beginning of Clinical Ethics Consultation
Functions, Operations and Policy of a Volunteer Ethics Committee: A Quantitative and Qualitative Analysis of Ethics Consultations from 2013 to 2018
2022, HEC Forum

View all citing articles on Scopus

View full text

ORIGINAL ARTICLEReport of 255 Clinical Ethics Consultations and Review of the Literature

OBJECTIVE

METHODS

RESULTS

CONCLUSIONS

Section snippets

Case Identification and Evaluation

RESULTS

DISCUSSION

CONCLUSIONS

Am J Med

Comprehensive Accreditation Manual for Hospitals: The Official Handbook: 2006 CAMH

Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine

Development of a hospital ethics committee: lessons from five years of case consultations

Camb Q Healthc Ethics

Effectiveness of an ethics consultation service

J Fam Pract

Salt Lake City VA Medical Center's first 150 ethics committee case consultations: what we have learned (so far)

HEC Forum

Activities of an ethics consultation service in a tertiary military medical center

Mil Med

ORIGINAL ARTICLE
Report of 255 Clinical Ethics Consultations and Review of the Literature