Face-to-face communication is a cornerstone of ethics consults. Today, because of the ongoing COVID-19 crisis, consults are handled remotely.
“This requires new techniques for communicating with all stakeholders,” says D. Micah Hester, PhD, a clinical ethicist at Arkansas Children’s Hospital and chair of the University of Arkansas for Medical Sciences’ Department of Medical Humanities and Bioethics.
Usually, ethicists gather input from many people affected by a patient’s care situation. Now, they have to carry out these tasks by phone or through a screen. “Remote consults are being done by phone, FaceTime, or any other legitimate communication medium — the more secure, of course, the better,” Hester explains.
The same is true if ethicists are meeting with hospital leaders, which is happening much more often. “Clinical ethicists have refocused priorities somewhat away from bedside consultation,” Hester reports.
They are more involved in the development of ethically grounded guidelines of care during a pandemic and educational materials. “Work with hospital leadership is typically done through an online meeting platform like Zoom or WebEx,” Hester notes.
The need to avoid in-person communication is a particular challenge for ethicists. “All consultants must change their practices, especially minimizing face-to-face encounters, because of the risk of transmission and the need to preserve PPE [personal protective equipment] in the hospital,” Hester says.
Ethicists conduct “teleconsults” either at home or in office with doors closed and physical distance from co-workers. “Sometimes, access to records and policies can only happen through institutional computers on the local area network,” Hester explains.
Ethicists at Houston Methodist Hospital are handling almost all consults remotely. “It’s definitely been a shift,” says Janet Malek, PhD, director of the biomedical ethics program for the Houston Methodist System.
Normally, ethics consults include plenty of talking, mostly in-person, with patients, families, and clinicians. The remote consults miss all the communication that happens through facial expressions and body language. “Phone-based communication loses that. It is harder to be effective. We find it is really important to actually be in the same room,” says Malek, associate professor at Baylor College of Medicine’s Center for Medical Ethics and Health Policy.
For example, a family member’s body language, or nurse’s facial expression, can signal he or she disagrees with others. “This can lead to further discussions,” Hester observes. “Without those cues, it is difficult to dig deeper sometimes.”
For now, ethicists conduct in-person consults only when it is absolutely necessary. “We are only going into the hospital for extraordinary situations,” Malek reports.
If it is a large, multidisciplinary meeting with family members present, “it’s hard to imagine being effective in that role if conversations are being held via WebEx,” Malek offers.
In-person consults also might happen if a high-stakes decision is made. “We agreed that we will only go into the hospital if the issue is important enough, and if we can’t effectively help remotely,” Malek adds.