Author(s): La Puma J, Stocking CB, Silverstein MD, DiMartini A, Siegler M
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Abstract A newly established formal ethics consultation service in a university teaching hospital was prospectively evaluated. A physician-ethicist interviewed and examined patients, interviewed family and others as needed, and entered a formal consultation note in the medical record. The requesting physician and the consultant independently completed structured questionnaires. Fifty-one consultation requests were received from 45 physicians from seven departments between July 1, 1986, and June 30, 1987. Seventeen (33\%) of 51 patients were in the intensive care unit, and 19 patients (37\%) were fully oriented at the time of consultation. Overall, 61\% of the patients survived to leave the hospital. The requesting physician sought assistance with withholding or withdrawing life-sustaining treatment in 49\% of cases, with resuscitation issues in 37\%, and with legal issues in 31\%. Assistance with more than one issue was sought in 39 cases (76\%). In 36 cases (71\%), the requesting physician stated that the consultation was "very important" in patient management, in clarifying ethical issues, or in learning about medical ethics. We conclude that ethics consultation performed by physician-ethicists provides useful, clinically acceptable assistance in a teaching hospital. KIE: The Center for Clinical Medical Ethics at the University of Chicago Hospitals and Clinics established a formal ethics consultation service in July 1986. Fifty-one subsequent requests for consultations by attending physicians were studied by La Puma, et al., to determine the actual clinical role of the new service. The authors sought to describe (1) the characteristics of the patients whose physicians requested consultation, (2) the reasons physicians sought consultation, from the point of view of the physician and the ethics consultant, and (3) if and how physicians found ethics consultation helpful. Three cases illustrating the role of the ethics consultants in patient care are presented. The authors conclude that by functioning as an objective clinical voice in nonurgent but very difficult cases, an ethics consultation service can help physicians "identify, analyze, and resolve ethical issues in patient care."
This article was published in JAMA
and referenced in Journal of Palliative Care & Medicine