As someone who has done clinical ethics consultations for many years I long ago reached the conclusion that many of the so-called ethical problems that we encounter during ethics consultations could be prevented if only a more constructive line of communication had been established from the beginning of the patient’s hospital stay. Let me specify just what kind of patients and families I have in mind, the kind of communication I am talking about and the type of intervention that is needed.
Let’s face it, most patients come to the hospital with an identifiable medical problem about which there is little controversy, so the physician can diagnose and treat with a predictable, usually favorable, outcome. These are not the cases for which we get called on to do ethics consultations, nor are they the cases that take excessive amounts of time and create significant emotional stress such as cases that involve conflicts. In the less common cases where serious conflicts between various parties emerge, we are usually dealing with patients who have more medical problems, which often involve the risk of dying. The patient often lacks capacity and is unable to speak his or her mind about the goals of care and how far to use aggressive medical interventions. This means that families or loved ones of the patient must speak for the patient, i.e. serve as surrogates, and communicate with physicians about care plan goals and the appropriateness of particular procedures such as CPR in the event of cardio-pulmonary arrest. To say the least, this is a stressful role for families and loved ones.
The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.