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Ethics Consultation: High Ideals or Unrealistic Expectations?
- Jeffrey Spike, PhD; and
- Jane Greenlaw, JD
- From University of Rochester Medical Center; Rochester, NY 14642
Ethics consultation evolved out of the field of bioethics, which was itself largely a product of the 1970s. Thus, when the American Society for Bioethics and Humanities report “Core Competencies for Health Care Ethics Consultation” was commissioned 4 years ago (1), the oldest ethics services had been in existence for barely 20 years and were in the adolescent stage of development—with high ideals and unrealistic expectations. The report represented the opportunity to evaluate the progress of and set future agendas for ethics consultation.
The report makes an informative starting point for someone interested in learning about ethics consultation. However, because it is the work of a consensus panel, the report softens or avoids some points of disagreement. This commentary tackles four such points and highlights the critical weaknesses of some of the approaches that the consensus panel presents as viable options. The four issues that we find problematic concern committees versus individual consultants, interdisciplinary competency, practical wisdom versus character, and financial support for ethics services.
Committees versus Consultants
The committee approach to ethics consultation may be effective in long-term care settings. However, it becomes unwieldy in acute care settings because it is difficult to convene a quorum of a 12- to 15-member committee in less than 72 hours. A second problem with committees performing consultations concerns the common practice of appointing members because of their job descriptions rather than because of their interest or experience in ethics. A third problem is the danger of “groupthink.” One member, such as the most politically powerful person (a member of the hospital administration or the hospital attorney, for example), can easily and sometimes inadvertently dominate the decision-making process. But in our view, the greatest problem with the committee approach is that ethics consultation must allow patients, …
