RATIONALE:

1. Consultations are offered as a service  and are advisory  in nature.
2. Consultations are not binding on the requesting person.
3. THE FINAL DECISION IN AN ETHICS CONSULTATION IS RESERVED TO THE INDIVIDUAL(S) WHO ARE THE AUTHORIZED DECISION MAKERS.
4. Consultations are intended to provide a balanced discussion of a particular situation.
5. Consultations are intended to serve as a support and a resource to the requesting person.

FORMS OF CONSULTATION:

1. The requesting person may only need some information to dispel confusion or a misunderstanding.
2. At times the requesting person simply needs clarification  of his/her own concerns and interests in the particular situation.
3. A consultation may be needed to correct dysfunctional communication which has developed between conflicting parties.
4.There may be some prompt assistance required to promote and process deliberative efforts when an urgent situation requires immediate attention.
5. There may be a current case which presents particularly difficult issues and requires an extensive discussion by the widest representation possible in the Ethics Committee.

ETHICAL ISSUES (General Orientation):

Every clinical situation has an ethical dimension since each involves making decisions in light of value commitments and respect for the persons who are interacting in the situation. Clinical judgments themselves are never made independently of a value commitment to some professional standards. Thus, an ethical issue may emerge as a focal element at any point in the clinical situation.

ETHICAL ISSUES (Specific Concerns):

1. Issues may arise under the guise of conflicts between [persons] patients and family members, conflicts among family members, or conflicts involving health care professionals.
2. Approaches to treatment may be the conflicting issue.
3. Disagreements about values may be the issue
4. Identification, clarification, or interpretation of  patients' wishes  may be the issue.
5. Patients' rights may be the major concern.
6. The appropriate ethical principles that should govern a particular set of circumstances may need exploration.
7. The manner of communication for the parties involved in a dispute may be an issue since inappropriate communication may violate the dignity of the persons involved in a decision.
8. Conflicts may arise between the wishes of a patient or family and the policies of the hospital.
9. The professional integrity of caregivers may be at stake.
10. The prudent allocation of health care resources  may be an ethical component in a particular case.

CLICK HERE to examine a possible process for use in ethics consultations.

ETHICAL ISSUES (The Operative Principles):

1. DECISIONS SHOULD BE MADE AS CLOSELY TO THE BEDSIDE AS POSSIBLE AND BY THE PERSONS MOST DIRECTLY INVOLVED IN THE SITUATION.
2. There is frequently an ongoing need for clarity, negotiation, tolerance, and good will.
3. When application of this principle cannot be achieved, then the need for an ethics consultation arises.

SUGGESTED PROCEDURES:

1. One member - 24-hour "on call" duty - one week with a back-up member who will be the primary "on call" member in the following week.
2. The schedule will be coordinated by the Chair of the Ethics Advisory Committee.
3. Any health care professional can initiate a consultation.
4. Patients or families can initiate a consultation by asking a healthcare professional to request a consultation on their behalf.
5. The requesting person will contact the "on call" member by calling the switchboard operator who will contact the Ethics Committee "on call" member by either page, beeper, or telephone.
6. Upon contact the "on call" member, along with the requesting person will:

a. determine the ethical issue to be addressed:
b. determine the most appropriate forum for addressing the concern,
c. gather the pertinent information necessary for an effective consultation.

a. the "on call" Ethics Committee member;
b. the Chair of the Ethics Committee,
c. an ad hoc committee of the Ethics Advisory Committee,
d. the full Ethics Advisory Committee.