Structures of Clinical Ethics Consultation

Clinical ethics case consultation is provided in several ways: by an ethics consultative group as a whole (such as an ethics committee), by a subgroup of the consultative group, or by individual consultants. Clinical ethics case consultation by a large group has the potential for having diffused accountability and being depersonalized, bureaucratic, insensitive, closed-ended, and removed from the clinical setting. But it has the advantage of providing multiple perspectives and opportunities for queries from persons of diverse backgrounds, and for correcting the potential for narrow or idiosyncratic views of an individual consultant.

In contrast, clinical ethics case consultation by an individual consultant is an open-ended process that can extend over a period of time, and permit ongoing discussion and pursuit of issues that require clarification. The individual consultant can decide what information is necessary and obtain it firsthand. Interviews with patients, families, and health professionals can be scheduled flexibly and conducted in private settings more conducive to diminishing apprehension, establishing trust, sharing information, and allowing the kind of give-and-take that is so important to exploring emotionally powerful and intensely personal issues. Furthermore, an individual ethics consultant is more visible and accountable than a committee (Agich and Youngner). For these reasons, many ethics consultative groups and healthcare professionals have found the individual clinical ethics consultant more effective than the committee. Many ethics consultative groups have created a middle ground that involves small teams who serve as an extension of the ethics consultation group or ethics committee.

Some see an advantage to a relationship between the ethics consultant and an ethics consultative group or committee because the large group regularly can review the individual consultant's activities. This arrangement provides peer review and quality assurance for the consultant as well as education for the larger group or committee. The ethics consultant or consultation team can ask the entire group to become involved in particularly controversial or complex cases.

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