Clinical ethicists at Springfield, IL-based Memorial Medical Center suspected that ethics consultations about limiting treatment were being requested earlier in patients’ hospital stays for African-Americans than for other patients.
“It felt at times like there were ‘quality of life’ judgments made by hospital staff that made providers uncomfortable with certain care decisions made by minority patients or their families,” explains Christine Gorka, PhD, director of the Clinical Ethics Center.
Gorka and colleagues decided to find out if the ethicists were right about race playing a role in the timing of ethics consults. The study, which was expanded to include gender, analyzed ethics consults for Medicare patients occurring in 2011 through 2014. All of the consults involved a question about limiting medical treatment. Some key findings include the following:
- Consultation requests for females were made, on average, 6.57 days after the patient was hospitalized, compared to 16.07 days for males.
- For African-American patients, the differences in admission-to-request intervals for female patients (5.93 days) and male patients (18.64 days) were greater than for Caucasian male and female patients.
- Ethicists spent more time on consultations with African-American males (316 minutes, on average), than on any other group studied. Consultations with Caucasian females (195 minutes, on average) turned out to be the shortest.
Bethany Spielman, PhD, JD, the study’s lead author and a member of Memorial’s Human Values and Ethics Committee, says, “We learned the ethics consultants’ hunch was true only for African-American women.”
Gorka found this especially surprising in light of the fact that a majority of the African-American female patients did not die or get discharged into hospice. It turned out that consultation requests for African-American men were made significantly later in their hospital stays than for other groups.
Another surprising finding: “Gender matters more than we originally thought it would,” says Spielman. The pattern of early consultation requests for females and later requests for males carried over to Caucasians, though the difference was not so striking as for African-Americans.
“None of the findings could be correlated with the presence or absence of an advance directive, the specific reason for the consult request, the attending physician’s specialty, or whether the patient ultimately died during the hospital stay,” notes Spielman.
Consider Possible Inequities
The American Society for Bioethics and Humanities recommends that ethics consultants “reduce disparities, discrimination, and inequities when providing consultations.”2 “Consultants will need to understand the race and gender interactions in their own institutions, and how they affect access to their consultation service,” says Spielman.
Gorka says ethicists should:
- consider their own biases;
- be active in addressing disparities that may be linked to unintended or unspoken biases.
“Practically speaking, that can mean building a safe space for patient/family values to be heard — or, sometimes, pushing back when a care plan has become derailed,” says Gorka.
REFERENCES
- Spielman B, Gorka C, Miller K, et al. Gender and race in the timing of requests for ethics consultations: A single-center study. J Clin Ethics 2016; 27(2):154-162.
- American Society for Bioethics and Humanities. (2011). Core competencies for healthcare ethics consultation (2nd ed.). Glenview, IL.
SOURCES
- Christine Gorka, PhD, Clinical Ethics Center, Memorial Medical Center, Springfield, IL. Phone: (217) 757-2353. Email: [email protected].
- Bethany Spielman, PhD, JD, School of Medicine, Southern Illinois University, Springfield, IL. Phone: (217) 545-4261. Email: [email protected].
Clinical ethicists at Springfield, IL-based Memorial Medical Center suspected that ethics consultations about limiting treatment were being requested earlier in patients’ hospital stays for African-Americans than for other patients.
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