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Many, if not most, ethics consults involve conflicts over withdrawal of life-sustaining treatment at the end of a patient’s life. Yet families are likely to be quite confused by commonly used terms such as “futile” and “potentially inappropriate.”
Once communication breaks down, it is difficult to rebuild. Clinicians, ethicists, and palliative care all should be talking to each other to be sure the family hears a common message.
Parties clash regarding comfort levels and how aggressive treatment should be. The lack of advance directives for so many patients exacerbates the problem. Nurses and other colleagues can join the conversations to assist or outright substitute for physicians who are unwilling or unable to engage deeply.
Clinicians must be careful about imposing medical staff priorities over patients’ priorities. Making presumptions is dangerous. Ethicists can help by explaining the provider’s responsibility to offer accurate information.
Clinicians know there is a clear ethical obligation to disclose errors to patients. However, the individual who finds a diagnostic error may not be a clinician in direct contact with the patient. Instead, it might be a researcher who is reviewing a chart long after a patient was discharged. What are researchers’ ethical obligations if they find an error no one else had discovered?
Children with disabilities can be organ donors, contributing to the supply. Excluding these patients as organ recipients would not be fair. A new policy statement does not consider intellectual and developmental disabilities (IDD) completely irrelevant, but the authors do not consider IDD to be dispositive for listing decisions either.
For emergency providers, time is precious. If a full-blown consult is not possible, ethicists can help discern the most critical aspect of a concern these clinicians may express. Quick, in-person responses; phone consults; and telemedicine consults all are possible approaches.
It may be worth giving time to the member without ethics knowledge who is willing to learn or a person still developing proper interpersonal skills. Leaders can help teach these skills, transforming borderline members into essential contributors.
Financial Disclosure: Author Stacey Kusterbeck, Physician Editor Arthur R. Derse, MD, JD, Nurse Planner Susan Solverson, RN, BSN, CMSRN, Editor Jonathan Springston, Editor Jill Drachenberg, Editorial Group Manager Leslie Coplin, and Accreditations Director Amy M. Johnson, MSN, RN, CPN, report no consultant, stockholder, speakers’ bureau, research, or other financial relationships with companies having ties to this field of study.
