Access to Ethics Consultation

Who should be able to request an ethics consultation? The answer to this question has political as well as moral implications. On the one hand, if only physicians have access to ethics consultation, many important ethical issues may never be examined (Tulsky and Lo). On the other hand, permitting patients, families, and other health professionals to request ethics consultation, especially without the physician's concurrence, might discourage more direct communication, disrupt physician-patient relationships, or undermine physician authority. The last possibility would be most threatening to authoritarian-minded physicians and very likely would challenge the traditional power structure of many hospitals. This may explain the gap between the argument in the literature for the ideal—that patients, families, and nurses should be able to request an ethics consultation—and the impression that many institutions do not permit, and almost none actively encourage, patient, family, or other health professional requests for ethics consultation.

The ability to ask for consultation is only one question concerning patient and family access to and control over the consultation process. Other questions include whether the patient or family should have authority to (1) call a consultation when the physician refuses to do so; (2) be informed routinely when consultations are requested by physicians; (3) veto physician-initiated consultation requests; (4) participate in all ethics consultations if they wish; and (5) receive verbal or written information about the consultant's findings and recommendations. Some argue that an insistence on a rights-based approach to these questions would doom ethics consultation services to failure in modern hospitals because of political considerations (Agich and Youngner).

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