Ethics Consultations

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The goal of ethics consultation is to support informed, deliberative decision making on the part of patients, families, physicians, and the health care team. By helping to clarify ethical issues and values, facilitating discussion, and providing expertise and educational resources, ethics consultants promote respect for the values, needs, and interests of all participants, especially when there is disagreement or uncertainty about treatment decisions.

Whether they serve independently or through an institutional ethics committee or similar mechanism, physicians who provide ethics consultation services should:

Seek to balance the concerns of all stakeholders, focusing on protecting the patient’s needs and values.
Serve as advisors and educators rather than decision makers. Patients, physicians, and other members of the care team, health care administrators, and other stakeholders should not be required to accept the consultant’s recommendations. Physicians and other institutional stakeholders should explain their reasoning when they choose not to follow the consultant’s recommendations in an individual case.
Inform the patients when an ethics consultation has been requested (if the request was not made by the patient or family) and seek patients’ agreement to participate. Ethics consultants should respect the decision of a patient or family not to participate, whether that decision is indicated formally through explicit refusal or informally by not taking part in discussions.
Respect the rights and privacy of all participants and ensure that appropriate steps are taken to protect the confidentiality of information disclosed in the consultation.
Have appropriate expertise or training—for example, familiarity with the relevant professional literature, training in clinical/philosophical ethics, or competence in conflict resolution— and relevant experience to fulfill their role effectively.
Adopt and adhere to policies and procedures governing ethics consultation activities in keeping with medical staff bylaws, including accountability and standards for documenting the consultation in the patient’s medical record.
Ensure that all stakeholders have timely access to consultation services in nonemergent situations and as feasible for urgent consultations.

AMA Principles of Medical Ethics: IV, V

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Council Reports

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Ethics Case Crisis Standards of Care

Related Opinions

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Opinion 1.1.1

Patient-Physician Relationships

At the heart of medicine lie relationships founded in a “covenant of trust” between patient and physician in which physicians commit themselves to responding to the needs and promoting the welfare of patients.

Opinion 1.1.7

Physician Exercise of Conscience

Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience is important for preserving the integrity of the medical profession as well as the integrity of the individual physician; Physicians’ freedom to act according to conscience is not unlimited; They are expected to provide care in emergencies, honor patients’ informed decisions to refuse life-sustaining treatment, respect basic civil liberties and not discriminate against patients on the basis of arbitrary characteristics.

Opinion 2.1.1

Informed Consent

Informed consent to medical treatment is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care.

Opinion 2.1.2

Decisions for Adult Patients Who Lack Capacity

Physicians should engage patients whose capacity is impaired in decisions involving their own care to the greatest extent possible, including when the patient has previously designated a surrogate to make decisions on his or her behalf.

Opinion 2.2.1

Pediatric Decision Making

In giving or withholding permission for medical treatment for their children, parents/guardians are expected to safeguard their children’s physical health and well-being and to nurture their children’s developing personhood and autonomy; Physicians should evaluate minor patients to determine if they can understand the risks and benefits of proposed treatment; The more mature a minor patient is, the better able to understand what a decision will mean, and the more clearly the child can communicate preferences, the stronger the ethical obligation to seek minor patients’ assent to treatment.

Opinion 4.2.1

Assisted Reproductive Technology

Assisted reproduction offers hope to patients who want children but are unable to have a child without medical assistance. In many cases, patients who seek assistance have been repeatedly frustrated in their attempts to have a child and are psychologically vulnerable. Those patients whose health insurance does not cover assisted reproductive services may also be financially vulnerable. Candor and respect are thus essential for ethical practice.

Opinion 5.3

Withholding or Withdrawing Life-Sustaining Treatment

A patient who has decision-making capacity appropriate to the decision at hand has the right to decline or halt any medical intervention even when that decision is expected to lead to his or her death, When a patient lacks appropriate capacity, the patient’s surrogate may halt or decline any intervention. There is no ethical difference between withholding and withdrawing treatment. When an intervention no longer helps to achieve the patient’s goals for care or desired quality of life, it is ethically appropriate for physicians to withdraw it.

Opinion 5.4

Orders Not to Attempt Resuscitation (DNAR)

Orders not to attempt resuscitation (DNAR orders) direct the health care team to withhold resuscitative measures in accord with a patient’s wishes. Physicians should address the potential need for resuscitation early in the patient’s course of care, while the patient has decision-making capacity, and should encourage the patient to include his or her chosen surrogate in the conversation.

Opinion 5.6

Sedation to Unconsciousness in End-of-Life Care

When a terminally ill patient experiences severe pain or other distressing clinical symptoms that do not respond to aggressive, symptom-specific palliation, it can be appropriate to offer sedation to unconsciousness as an intervention of last resort.

Opinion 6.1.1

Transplantation of Organs from Living Donors

Donation of nonvital organs and tissue from living donors can increase the supply of organs available for transplantation, to the benefit of patients with end-stage organ failure. Enabling individuals to donate nonvital organs is in keeping with the goals of treating illness and relieving suffering so long as the benefits to both donor and recipient outweigh the risks to both.

Opinion 10.7

Ethics Committees in Health Care Institutions

Ethics committees offer assistance in addressing ethical issues that arise in patient care and facilitate sound decision making that respects participants’ values, concerns, and interests. Ethics committees may also assist in ethics-related educational programming and policy development within their institutions.

Opinion 10.7.1