A close inspection of the medical record revealed conflicting information regarding a particular patient’s code status at University of Michigan Health System. The issue was identified and addressed due to an online comment system allowing for broad committee participation in ethics consultations.

The system was designed to “promote consistency and achieve consensus in services rendered, as well as to enable quality assurance,” says Andrew Shuman, MD, service chief of the clinical ethics service at University of Michigan’s Center for Bioethics and Social Sciences.1

Researchers analyzed 159 adult ethics consults recorded between January 2011 and May 2015. The most common comments were:

• requests for additional information;

• recommendations for additional services;

• references to formal policies or standards.

“The electronic venue created a meaningful and substantive discussion,” says Shuman. “The process appears to improve the overall quality of clinical ethics consultation.” Recommendations now reflect the input of diverse committee members.

“There is a focus on ensuring that case summaries, ethical analyses, and recommendations are accessible, clear, and specific,” says Shuman.

More Expertise Available

Input on ethics consults was previously limited to whoever happened to be on call when a request came in. The online system means more people can share insights on ethical dilemmas.

“It allows the considerable and varied expertise of the members of our ethics committee to be brought to bear on the dilemmas that arise in our clinic,” says Raymond De Vries, PhD, the center’s associate director.

Medical students are able to see how cases were debated and ultimately resolved. “This provides them with firsthand experience in ethics consultation that normally would be impossible,” says De Vries.

Most members of the ethics committee have full-time obligations elsewhere. They were typically unable to give feedback on consults, except post-hoc during monthly meetings. The online comment system has changed this.

“The folks doing the consult can get real-time, useful opinions of the nurses, philosophers, social scientists, and chaplains who are committee members, but are not right there in the midst of the consult,” says De Vries.


1. Hauschildt K, Paul TK, De Vries R, et al. The use of an online comment system in clinical ethics consultation. AJOB Empir Bioeth 2017; 8(3):153-160.


• Raymond De Vries, PhD, Associate Director, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor. Phone: (734) 615-8377. Email: rdevries@umich.edu.

• Andrew Shuman, MD, Clinical Ethics Service, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor. Phone: (734) 232-0120. Email: shumana@umich.edu.