Page 18 - Volume 70 Number 1
P. 18

General Session Review:
The Importance of Clinical
Ethics Consultations
Speaker: Andrew Shuman, MD
by Richard Burney, MD
At the general session of the WCMS on November 14, 2017, an overflow crowd heard from Andrew Shuman, MD, on “The Growing Importance of Clinical Ethics Consultation in Hospitalized Patients.” Shuman, an Assistant Professor of Otolaryngology, and has had a long-standing interest in ethics, and obtained additional training following his residency by completing fellowships in head and neck surgical oncology in the Department of Surgery at Memorial Sloan-Kettering Cancer Center and in medical ethics at Weill Medical College of Cornell University. He is Co-Director of the Program in Clinical Ethics, Chair, Adult Ethics Committee and Consultation Service at Michigan Medicine. His current research interests explore ethical issues involved in caring for patients with head and neck cancer, and in managing clinical ethics consultations among patients with cancer.
In his introduction, Shuman called attention to the pioneering work in the field of medical ethics of Albert Jonsen, whose book, A Short History of Medical Ethics, calls attention to the variety of new, unanswered questions today: “New techniques, from antibiotics to transplanted and artificial organs, genetic discoveries, and reproductive manipulations, together with the research that engendered them, \[have\] presented the public, scientists, doctors, and politicians with questions that had never before been asked.” These questions are not academic; they can often arise in the context of emotion-laden conflict.
Hospitals began to make clinical ethics consultation available, usually on a volunteer basis, in the 1970’s. The current era of ethics consultations really began, however, when the Joint Committee mandated ethics consultation services in 1991. This mandate led to increasing professionalization and setting of standards, which continues today.
While acknowledging that most of the requests received by the ethics committee are reactive, frequently related to difficult end of life situations, Shuman emphasized the equal importance of preventive activities that can avert difficult situations.
Shuman explained that the ethics committee does not make decisions for caregivers when they are faced with difficult decisions, but rather the purpose of the ethics consultation is to help clarify what the issues might be, and facilitate collective decision-making. They do this by:
 reviewing of the case to articulate the ethical question
 discussing the request with all those involved, caregivers and family
 offering suggestions about justifiable course of action
 helping mediate disputes
 documenting their work in the medical record
Final decisions are always made by the patient, family and health care team. The ethics committee does not dictate choices or take sides, nor does it make moral judgments; it is neither policeman nor legal counsel.
Preventive activities of the ethics committee include being present in the hospital units, making rounds and attending case conferences, in particular in the ICUs, and trying to identify potential conflicts by listening to doctors, nurses and others.
Shuman finished by presenting two cases for discussion. Both arose from actual clinical situations, and raised difficult questions that did not have “right” answers. These cases generated thoughtful audience participation that helped consolidate the lessons learned both about the kinds of ethical questions that can arise and the importance of well-trained, professional ethical consultation support in today’s medical world.
18 Washtenaw County Medical Society BULLETIN JANUARY / FEBRUARY / MARCH 2018

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