Remote Consults Expand Reach of Ethics, But Complex Cases Remain Challenging
Many ethics services are using remote approaches to communicate with clinicians, colleagues, patients, or family members. The extent to which they do so varies widely.
“Tele-ethics makes ethics consultation more available and provides a level of expertise that is simply not otherwise available,” says Gretchen M. Spars, MA, MDiv, HEC-C, co-director of ethics programming and Certificate in Bioethics coordinator at the University of South Dakota Sanford School of Medicine.
A virtual format “stands in the gap and shortens the distance,” says Spars, who co-authored a recent paper on this topic.1 Tele-ethics has made many conversations possible that would not have occurred. This has been the case for many years.
“However, the [COVID-19] pandemic has prompted even more innovative methods of connecting with healthcare workers, patients, and families for ethical deliberation,” Spars notes.
For other ethics services, remote approaches have not proven feasible for several reasons. “We are really not doing many tele-ethics consults,” reports Ian Wolfe, PhD, MA, RN, CCRN, HEC-C, a clinical ethicist at Children’s Minnesota.
During the height of the pandemic, ethicists at Children’s Minnesota used some virtual platforms and devices to attend care conferences and talk with parents. “Overall, it has proven quite difficult to really engage in difficult conversations virtually,” Wolfe laments.
Remote ethics consults helped families with non-acute decision-making, provided guidance for medical teams, and offered other institutions second opinions.
“It does not work well for complex cases where there are many specialties, particularly when there is an in-person provider team meeting. It becomes too difficult to mediate and facilitate if you are not in the room,” Wolfe shares.
Additionally, it is “near impossible” to collect data from nursing and other staff members in a virtual consultation.
“Overall, there is so much involved in orchestrating the social structure around these cases that tele-ethics is just not sufficient enough to provide any help, outside of simple ethical questions where there is no conflict,” Wolfe concludes.
- Freeman Cook A, Schellinger EL, Spars G, Freeman JW. Responding to the pandemic: The evolving role of tele-ethics in ethics consultation. S D Med 2021;74:80-82.
It is too difficult for an ethicist to mediate and facilitate if he or she is not physically present in the room.
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