Ethics in Health Care

Tasks and Methods

Health care ethics draws on a wide variety of tools from a number of disciplines. The diversity of tasks and methods used in the field can be illustrated by considering the following vignette.

• Mr. Decline is a 48-year-old man whose life is in jeopardy from end-stage kidney disease. In the past, he received dialysis regularly, but he recently discontinued all treatments. His physician has explained that without dialysis he will die very soon. However, Mr. Decline refuses dialysis because he says it is uncomfortable and inconvenient and he generally feels well. He says he will undergo dialysis when he needs it, but right now he feels fine.

Many hospitals in the United States have multidisciplinary ethics committees that provide clinical ethics consultations. The consultative services provided by ethics committees can be used to educate practicing health care professionals, but they are more commonly called on to facilitate the resolution of disputes. Methods for dispute resolution include neutral framing of ethical questions, soliciting additional consultations (e.g., psychiatric or legal consultations), mediation, determining who should make decisions, facilitating discussions, and providing nonbinding advice. In the [Page 338]case of Mr. Decline, a clinical ethicist would likely review Mr. Decline's chart, interview him and the staff who regularly provide care to him, and request a psychiatric consultation to evaluate his capacity to make medical decisions. If the psychiatric evaluation revealed that Mr. Decline did not have the capacity to make informed decisions, the ethics consultant would likely search for advance directives and/or next of kin for input. If no relatives could be found, the ethics consultant might work with a local court for the appointment of a guardian ad litem. On the other hand, if Mr. Decline were found to have decision-making capacity, his wish to decline treatment would be honored. This is grounded in the legal and ethical doctrine of patient self-determination, which recognizes a competent adult patient's right to refuse medical treatments.

Clinical ethicists who work in health care environments frequently play additional roles in cases involving issues such as informed consent and decisionmaking capacity. For example, they may provide education to staff, may advise on health care policies, or serve as expert witnesses in legal cases that involve related disputes.

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