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Tips for Making ‘Tele-Ethics’ Work

By Stacey Kusterbeck, Special for

For more than 20 years, Alexander A. Kon, MD, HEC-C, FAAP, FCCM, has been conducting tele-ethics consults. “A lot has changed, but mostly it has stayed the same,” says Kon, president of Ethics Consultants, Inc., and medical director of the pediatric ICU and inpatient pediatrics at Community Children’s at Community Medical Center in Missoula, MT.

Ideally, the remote ethicist works collaboratively with someone on site at the hospital. “Having someone, or a small team, who is local and has some experience with ethics consultations, working under the guidance of the remote ‘expert,’ is a best-case scenario,” Kon offers.

Some hospitals do not allow people off site to access policies and procedures or electronic health records (EHRs) because of technical and security issues. “A skilled ethics consultant working with an administrator who can access the EHR and hospital policies can often be sufficient,” Kon suggests.

The remote ethicist can conduct interviews with individuals by phone or videoconferencing. Kon has run large meetings via videoconferencing with ethics committee members, clinicians, patients, and family. In some of those cases, all the local people were in one large room, with Kon on a remote video feed. “Having everyone in the same room really facilitates conversation,” Kon says.

As with traditional family meetings, the ethicist’s role is to facilitate discussion, point out key elements, and ensure everyone who wishes to contribute can. The remote model sometimes presents certain communication challenges. “It can be very difficult to lead such discussions,” Kon notes. “But with experience, the facilitator can lead a very productive meeting.”

In other cases, everyone is participating via videoconference. By participating through their own computers, everyone can be on the same footing. “As the leader, I am at no disadvantage compared to the others, and can fully participate. However, having everyone on Zoom or Teams often leads to a less robust discussion than when they are all in the same room,” Kon notes.

To make tele-ethics as successful as possible, Kon offers these technical considerations:

If the ethicist is leading a larger meeting, where multiple participants are in one room, there should be multiple microphones around the room. This ensures the remote expert (and anyone else who is participating remotely) can clearly hear all of the conversation. “During such meetings, it is not uncommon for some folks to make quick, somewhat quiet, comments,” Kon notes. “Those remarks are often key.”

Fully hearing everything that is said in the room — even side comments – is essential. This often requires more microphones than IT provides. “Ideally, there should be a microphone in front of every participant, and those microphones should be live at all times,” Kon advises.

Of course, it’s much easier for everyone to hear when only one person talks at a time. However, if only one microphone is live at one time, it can stifle conversation. For the ethicist leading the meeting, the challenge is to ensure that no one person, or small group of people, monopolizes the conversation.

Allowing multiple people to talk at once is harder for the leader, Kon acknowledges: “However, allowing a ‘natural’ discussion allows folks to disclose their true thoughts and feelings,” he says.

If patients, family members, or friends are participating in videoconferencing (either one on one with the remote consultant or as part of a larger meeting group), technical support must be available locally. Many people run into problems with the hospital Wi-Fi, connectivity, or downloading the necessary applications. “Making it easy for patients, family members, and friends is key to gaining trust and building rapport,” Kon offers.

For more on tele-ethics, be sure to read the upcoming August issue of Medical Ethics Advisor.