Complex Ethics Consultations

Clinical ethicists encounter the most emotionally eviscerating medical cases possible. They struggle to facilitate resolutions founded on good reasoning embedded in compassionate care. This book fills the considerable gap between current texts and the continuing educational needs of those actually facing complex ethics consultations in hospital settings. 28 richly detailed cases explore the ethical reasoning, professional issues, and the emotional aspects of these impossibly difficult consultations. The cases are grouped together by theme to aid teaching, discussion and professional growth. The cases inform any reader who has a keen interest in the choices made in real-life medical dilemmas as well as the emotional cost to those who work to improve the situations. On a more advanced level, this book should be read by ethics committee members who participate in ethics consultations, individual ethics consultants, clinicians who seek education about complex clinical ethics cases, and bioethics students.

Clinical ethicists encounter the most emotionally eviscerating medical cases possible. They struggle to facilitate resolutions founded on good reasoning embedded in compassionate care. This book fills the considerable gap between current texts and the continuing educational needs of those actually facing complex ethics consultations in hospital settings. 28 richly detailed cases explore the ethical reasoning, professional issues, and the emotional aspects of these impossibly difficult consultations. The cases are grouped together by theme to aid teaching, discussion and professional growth. The cases inform any reader who has a keen interest in the choices made in real-life medical dilemmas as well as the emotional cost to those who work to improve the situations. On a more advanced level, this book should be read by ethics committee members who participate in ethics consultations, individual ethics consultants, clinicians who seek education about complex clinical ethics cases, and bioethics students.

This book addresses new and evolving thorny issues in clinical ethics consultation. It is a book for our time. The contributors provide essential critical reflection on the standards and methods of training clinical ethics consultants as the field seeks to professionalize. This collection incorporates both North American and European experts, offering different perspectives on issues such as marginalized populations, the opioid epidemic, complex discharge, micro-managing families, and continually challenging issues at the end-of-life, such as determinations of brain death, physician-assisted death, and futility. The authors engage the complexities of choosing for others when making decisions for incapacitated adults and pediatric patients. This volume engages with the growing literature in these debates and offers new perspectives from both academics and practitioners. The readings are of particular interest to bioethicists, clinicians, ethics committees, and students in bioethics and beyond. These new essays advance discussions in the professionalization and certification of ethics consultants and offer crucial insights on new and evolving thorny issues in the practice of clinical ethics consultation.

This volume brings together researchers from different European countries and disciplines who are involved in Clinical Ethics Consultation (CEC). The work provides an analysis of the theories and methods underlying CEC as well a discussion of practical issues regarding the implementation and evaluation of CEC. The first section deals with different possible approaches in CEC. The authors explore the question of how we should decide complex cases in clinical ethics, that is, which ethical theory, approach or method is most suitable in order to make an informed ethical decision. It also discusses whether clinical ethicists should be ethicists by education or rather well-trained facilitators with some ethical knowledge. The second chapter of this book focuses on practical aspects of the implementation of CEC structures. The analysis of experienced clinical ethicists refers to macro and micro levels in both developed and transitional countries. Research on the evaluation of CEC is at the centre of the final chapter of this volume. In this context conceptual as well as empirical challenges with respect to a sound approach to judgements about the quality of the work of CECs are described and suggestion for further research in this area are made. In summary this volumes brings together theorists and healthcare practitioners with expertise in CEC. In this respect the volume serves as good example for a multi- and interdisciplinary approach to clinical ethics which combines philosophical reasoning and empirical research.

In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns—whether ethics consultation is best done by individuals, teams, or committees; how an ethics consult service should be structured; the need for institutional support; and techniques and programs for educating and training staff—without neglecting more theoretical considerations, such as the importance of character or the viability of organizational ethics.

The National Institutes of Health Clinical Center's Bioethics Consultation Service draws on a decade of experience to share a collection of their most interesting and informative research ethics consultations. The result is insight into the ethical issues that arise in clinical research and the practice of research ethics consultation.

This is a book about clinical ethics consultation by two practitioners who together have done more than 700 consultations. There is not another authoritative book like it. Practical rather than theoretical in scope, the book addresses strategies for conducting consultations, relating to patients at the bedside, investigating the ethical issues, making recommendations, following up on cases, and keeping records. Chapters include issues such as the need for training, the skills needed, the problem of certification, how to set up a practice, financial compensation and billing, and the relation of the consultant to committees, particularly ethics committees. The authors include reflections about learning clinical ethics and education of committees, hospital staff, and the general public about issues that arise. The purpose is to help ethics consultants improve their conscious assessment of their work, both how they go about it and its legitimacy for patients, health care providers, and hospitals. The orientation is primarily on clinical care of patients, because the goal of such consultations is always aimed to improve patient care. Other ethics consultants might work to develop institutional policies. Although that is touched on in the book, it is not the primary goal of the authors. The book is aimed at the practitioner in bioethics in a clinical setting.

This study guide provides an unfolding approach to 12 cases--9 involving adult patients, 3 involving minors--on various topics in clinical ethics. The presentation of these complex cases mimics the way that they evolve incrementally in the clinical setting: Patient and family narratives are interwoven with skills-based, reflective study questions that encourage critical thinking on the part of ethics consultants, ethics committee members, students, and other healthcare professionals. The authors--the members of the ASBH Clinical Ethics Consultation Affairs (CECA) Committee--have included tips related to communication and decision making in medicine, including strategies for guiding fruitful patient reviews, elucidating patients' or surrogates' concerns or perspectives, and conducting family meetings. This resource will be useful to all healthcare professionals and students seeking to build their competencies, from the basic skills used to address common ethical issues to advanced consultative skills that can be used to address complex ethical concerns.