A Qualitative Report of Dual Palliative Care/Ethics Consultations: Intersecting Dilemmas and Paradigmatic Cases

Department of Internal Medicine, University of Rochester, Strong Memorial Hospital, Rochester, New York, USA.
The Journal of clinical ethics (Impact Factor: 0.47). 02/2008; 19(3):204-13.
Source: PubMed
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Available from: Julie W Childers, Jan 07, 2015
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    ABSTRACT: Very few patients are presented to ethics committees, and individual ethics consultations are a response to this situation. At the intensive care unit (ICU) in Clínica Alemana, Santiago Chile, an ethics consultation system was organized coordinated with the ethics committee. To report an evaluation of this ethics consultation system. Analysis of the first 50 cases analyzed in the consultation system. Analysis of the responses of intensive care physicians to a questionnaire about the main ethical problems that they face in their work. The consultation system is mainly required by the ICU staff and reports to the ethics committee. Fifty four percent of patients subjected to consultation were aged over 80 years. The main diagnoses were neurological, oncological or cardiopulmonary problems. The ethical problems identified were treatment limitation (62%), proportionality or futility (42%), need of a peaceful death (36%), lack of anticipated decisions (28%), disagreement between physicians and patient's family (24%), undefined subrogation (14%), and abuse of public resources (14%). Twenty six of 31 ICU physicians answered the questionnaire, using a 1 (min) to 7 (max.) scale. They found that consultation is helpful for decision making (6.3), useful for improving ethical perception (6.0), supportive for staff (6.5), good for patients (6.3), supportive for families (6.7), and timely performed (5.2). As a complement for the ethics committee's work, consultation is a valid alternative for ethics counselling and a support for physicians and patient's families. Its implementation depends on the particularities of each health institution.
    Full-text · Article · Jul 2010 · Revista medica de Chile
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    ABSTRACT: Assisting patients and their families in complex decision making is a foundational skill in palliative care; however, palliative care clinicians and scientists have just begun to establish an evidence base for best practice in assisting patients and families in complex decision making. Decision scientists aim to understand and clarify the concepts and techniques of shared decision making (SDM), decision support, and informed patient choice in order to ensure that patient and family perspectives shape their health care experience. Patients with serious illness and their families are faced with myriad complex decisions over the course of illness and as death approaches. If patients lose capacity, then surrogate decision makers are cast into the decision-making role. The fields of palliative care and decision science have grown in parallel. There is much to be gained in advancing the practices of complex decision making in serious illness through increased collaboration. The purpose of this article is to use a case study to highlight the broad range of difficult decisions, issues, and opportunities imposed by a life-limiting illness in order to illustrate how collaboration and a joint research agenda between palliative care and decision science researchers, theorists, and clinicians might guide best practices for patients and their families.
    Full-text · Article · Sep 2011 · Journal of palliative medicine
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    ABSTRACT: Despite the emergence of clinical ethics consultation as a clinical service in recent years, little is known about how clinical ethics consultation differs from, or is the same as, other medical consultations. A critical assessment of the similarities and differences between these 2 types of consultations is important to help the medical community appreciate ethics consultation as a vital service in today's health care setting. Therefore, this Special Article presents a comparison of medical and clinical ethics consultations in terms of fundamental goals of consultation, roles of consultants, and methodologic approaches to consultation, concluding with reflections on important lessons about the physician-patient relationship and medical education that may benefit practicing internists. Our aim is to examine ethics consultation as a clinical service integral to the medical care of patients. Studies for this analysis were obtained through the PubMed database using the keywords ethics consultation, medical consultation, ethics consults, medical consults, ethics consultants, and medical consultants. All English-language articles published from 1970 through August 2011 that pertained to the structure and process of medical and ethics consultation were reviewed.
    No preview · Article · Apr 2012 · Mayo Clinic Proceedings
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