Ethics consultants: Could they do better?

Journal of Clinical Ethics

Volumn 10, Issue 1, 1999, Pages 13-25

  Howe, Edmund G ^a  

^a UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANGER; BIOETHICS AND PROFESSIONAL ETHICS; CONFLICT; CONSENSUS; CORE COMPETENCIES FOR HEALTH CARE ETHICS CONSULTATION (SHHV-SBC TASK FORCE); ETHICIST; ETHICS; GROUP PROCESS; HUMAN; HUMAN RELATION; MEDICAL ETHICS; PATIENT COMPLIANCE; PATIENT REFERRAL; PROFESSIONAL COMPETENCE; PROFESSIONAL PATIENT RELATIONSHIP; PROFESSIONAL STANDARD; REVIEW; STANDARD; TRUST; UNITED STATES;

BIOETHICS AND PROFESSIONAL ETHICS; CORE COMPETENCIES FOR HEALTH CARE ETHICS CONSULTATION (SHHV-SBC TASK FORCE); PROFESSIONAL PATIENT RELATIONSHIP;

ANGER; CONSENSUS; DISSENT AND DISPUTES; ETHICISTS; ETHICS COMMITTEES, CLINICAL; ETHICS CONSULTATION; ETHICS, MEDICAL; GROUP PROCESSES; HUMANS; PATIENT COMPLIANCE; PROFESSIONAL COMPETENCE; PROFESSIONAL ROLE; PROFESSIONAL-FAMILY RELATIONS; REFERRAL AND CONSULTATION; TRUST; UNITED STATES;

EID: 0033087894     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (11)

1. See, as an example, E. Fox and C. Stocking, "Ethics Consultants' Recommendations for Life-Prolonging Treatment of Patients in a Persistent Vegetative State," Journal of the American Medical Association 270, no. 21 (1 December 1993): 2578-82.
2. These differences in presupposition and approach are, in application, relative, not absolute. As the authors of the Core Competencies indicate, "Most approaches fall between . . . extremes," and no approach is "applicable to every kind of consult." This alternative approach is not intended to replace ethics facilitation. Rather, this approach is adjunctive, and the discussion is intended to effect how and when ethics facilitation is used.
3. It is common practice in psychiatry for one psychiatrist to dispense medications and another to do psychotherapy with the same patient for just this reason.
4. J.A. McClung et al., "Evaluation of a Medical Ethics Consultation Service: Opinions of Patients and Health Care Providers," American Journal of Medicine 100 (April 1996): 456-60, p. 460. But see R.D. Orr et al., "Evaluation of an Ethics Consultation Service: Patient and Family Perspective," American Journal of Medicine 101 (1996): 135-41. In this study, this discrepancy was not found.
5. J.A. McClung et al., "Evaluation of a Medical Ethics Consultation Service: Opinions of Patients and Health Care Providers," American Journal of Medicine 100 (April 1996): 456-60, p. 460. But see R.D. Orr et al., "Evaluation of an Ethics Consultation Service: Patient and Family Perspective," American Journal of Medicine 101 (1996): 135-41. In this study, this discrepancy was not found.
6. M. Foucault, "The Discourse on Language," in The Continental Philosophy Reader, ed. R. Kearney and M. Rainwater, trans. R. Swyero (New York: Routledge, 1996), 339-60, p. 343.
7. Another primary care team "revealed that not only were they overwhelmed by the number of consult team members . . . , they felt that the consult team had already formed its own opinion . . . and considered it imprudent to disagree with several of the members whom they viewed as authority figures." E. Olson, "Early Experiences of an Ethics Consult Team," Journal of the American Geriatric Society 42 (1994): 437-41, p. 440.
8. Ethics consultants' discourse with patients acts on patients to the extent that it attempts to move them to adopt a different view. J.L. Austin, How to Do Things with Words (Cambridge, Mass.: Harvard University Press, 1975).
9. Consciously or unconsciously, if patients or family members feel defensive, they will be less able to both acquire new insight or to express honestly what they feel.
10. F. Broucek and W. Ricci, "Self-Disclosure or Self Presence?" Bulletin of the Menninger Clink 62, no. 4 (Fall 1998): 427-38, p. 435.
11. This statement, though made in the context of psychotherapy, is applicable to ethics consultation. J. Greenberg, "Self-Disclosure: Is It Psychoanalytic?" Contemporary Psychoanalysis 31 (1995): 193-205, p. 197.