By Stacey Kusterbeck
When is it appropriate to request a clinical ethics consultation, and what does the process entail?
Many patients and family members, and even some clinicians, are unaware of the basics of what ethicists do or even how to contact them. However, many ethics services do not post any information at all on their institutional websites, a recent study found.1
“Ethicists within hospital settings should consider how they wish to be perceived by both their institutions and the public. An essential part of this is determining the level of visibility they want to achieve,” says Erica Koranteng, MBChB, MBE, the study’s lead author and a bioethics research fellow at Dana-Farber Cancer Institute.
Koranteng and colleagues determined whether information on clinical ethics consultation services was available on the websites of National Cancer Institute (NCI)-Designated Cancer Centers, and, if so, what content was posted. A significant number of websites had no information about ethics consult services. “Including ethics consultation service information on hospital websites is crucial because these sites can serve as primary information sources, particularly for patients and families who may be hesitant to directly ask healthcare providers about ethics consultations,” emphasizes Koranteng.
Of 70 websites, only 38 had information on clinical ethics consultation services. Even for those websites, the information provided often was lacking in detail. “This was surprising, given that these websites generally offered comprehensive details about other services,” says Koranteng.
Most websites included a mission statement and an explanation of what constitutes an ethics consultation. However, few websites described the ethics consult process. “There was a lack of emphasis on key ethics consultation values, such as active listening, engagement, and communication, which are central to many ethics consult service processes,” says Koranteng. Few websites gave information on the leadership of the ethics consult service. This could diminish the perceived transparency and reliability of the service, according to the authors.
For ethics programs, lack of information on hospital websites is a lost opportunity. “A webpage represents a low-effort, yet highly effective means of enhancing accessibility. A well-crafted webpage can demystify the ethics consult service and ensure that it is perceived as an approachable, supportive resource,” asserts Koranteng.
The researchers did not survey respondents on what should be included on an ethics consultation webpage. However, as clinical oncologists and ethicists, the study authors recommended that ethics programs include:
• an explanation of what an ethics consult is, with clear examples of situations that may necessitate one;
• a statement of who can request a consult;
• an outline of the procedure of how to obtain a consult;
• a description of the ethics consult process;
• details on the leadership of the ethics service.
Although the process varies somewhat depending on the nature of the case, ethicists can outline the general steps involved. Ethicists also can specify some techniques employed, such as mediation or facilitation. “This helps set realistic expectations and mitigates the risk of unnecessary conflict,” says Koranteng.
At Geinsinger Health, clinicians are made aware of the ethics consultation service through internal marketing efforts. The ethics consult service’s website is directed primarily toward patients and families. “Ethics consult services should be transparent on websites about what they do, when they are available, and how to contact them,” says F. Daniel Davis, PhD, HEC-C, a professor of bioethics and associate chief of clinical ethics at Geisinger Health.
Under the heading “What is the Clinical Ethics Advice and Consultation Service?” the website offers this explanation: “The Service supports patients, their families (as well as surrogate decision-makers) and their healthcare teams whenever difficult ethical questions or concerns arise or when better communication — within families or between clinicians and patients and their families — would be helpful.”
Patients and families are the least frequent requestors of Geisinger Health’s ethics services, but those who do contact ethicists usually mention that they saw the contact information on the website. Getting information out about what ethics can offer is important for many reasons, according to Davis.
“At a time when there’s a drive to promote transparency — such as a hospital’s prices and its performance on quality metrics — and, to advance patient-centered decision-making, publicizing consult services serves both aims,” says Davis.
- Koranteng E, Cernik C, Gallagher E, et al. Clinical ethics consultation services: Public-facing information on NCI-designated cancer center websites. Oncologist 2024; Jul 23. doi: 10.1093/oncolo/oyae173. [Online ahead of print].
