Consultants possess a specific set of skills who provide expertise for an identified gap. Ethics consultation provides expertise in bioethics, either for a specific patient case, an organizational issue, or a research concern. It is a process to provide support and education to identify the ethical concerns as well as to recommend how to handle said concerns. While most hospitals have ethics committee, only some have an ethics consultant on staff.
The responsibility of ethics consultations defaults to one of two options. First, the ethics committee can address all consult requests. This requires a committee quorum and the coordination of many schedules. The second option is to assign the consult requests to current employees in addition to their full work load.
While the best practice would be to employ a full time ethics consultant, sometimes staffing this position full time is not an option. Those who are full time ethics consultants specialize in ethics and clinical consulting methodology. They have obtained the necessary skills and knowledge to conduct ethics consultations. The two options – either the ethics committee model or the current staff model most often fail to have the skills or effective use of resources to match the expertise of a full time ethics consultant.
Having the entire ethics committee act as the ethics consultant is unnecessary most of the time. Using the entire ethics committee to address a specific case can be overwhelming for the patient or family and often involves an unnecessary number of individuals. Some ethics consultations only require a simple conversation to address a minor issue. Having to assemble an entire committee is often a waste of time and resources. In addition, the ethics committee often only meets once a month at predetermined times, making it difficult to address time sensitive consult requests. Assigning the ethics consulting responsibility to a current staff member can be a successful option, but must be done with careful consideration.
The staff members assigned to ethics consultations may or may not have an ethics background and the responsibility of these consultations is added to an already full work load. While these staff members are trying to fill the role of consultant, there needs to be a level of skill and education that goes along side the assignment of responsibility. While neither of these options is perfect, they are viable options as long as the necessary education and training is included.
To strive for best practice, education and training should be conducted not just for ethics consultation, but also for bioethics in general. Everyone on the ethics committee and any staff that participates in ethics consultations, needs to have a basic understanding of bioethics. Continuing education and training is vital to the healthcare field and ethics is no different. Once the general bioethics education and training is obtained, ethics consultations can move forward. The ethics committee should oversee the ethics consultations, by assigning the responsibility to current staff. Education and training must be included to qualify the current staff to act as the ethics consultant. The staff member must have a clear understanding of their responsibilities for not just their current job, but also for the new role as an ethics consultant and be aware which role they are fulfilling at any given time. Additional resources and expertise should be made available for unusual or difficult cases. They need to know that support is available and are not expected to know everything regarding bioethics since this is not their primary area of expertise.
By providing better education and resources, having current staff act as an ethics consultants a practical approach. The ethics consultations can function as best practice while using its staff and resources most effectively. It takes effort in the beginning to seek out collaboration and expertise, but in the end it provides a vital and achievable ethics consultation service.
Leah Jeunnette is an intern for the Institute of Consultative Bioethics, based in Pittsburgh, Pennsylvania. She is currently finishing her doctoral work in bioethics at Duquesne University.
For more information, visit www.icbioethics.com.