Ethicists Can Counter Clinicians’ Perceptions of Consults as Unhelpful
June 1, 2025
By Stacey Kusterbeck
Ethicists work hard to make sure that all stakeholders in complex cases are heard. They rely on education, experience, and expertise to come up with recommendations for ethically justifiable approaches. Yet, when the consultation is completed, ethicists usually do not know how the clinical team feels about the process.
Some clinicians view ethics committees as unhelpful and avoid them when faced with an ethical dilemma, a recent study found.1 Researchers interviewed 113 clinicians at three academic medical centers on collaborating with ethics committees regarding end-of-life decision-making. Clinicians who perceived ethics committees as having limited utility cited these reasons:
- consults were too time-consuming and labor-intensive;
- there was no guarantee of a clear path forward for clinical decision-making;
- there was lack of enforceability for decisions made by the ethics committee (for instance, a clinician could disregard the ethicist’s recommendation of a unilateral do-not-resuscitate order by performing cardiopulmonary resuscitation);
- ethics committees were perceived as primarily focused on compliance with hospital policies or legal requirements. Some clinicians viewed the ethics committee as being mostly concerned with protecting the hospital from liability as opposed to strictly being focused on moral deliberation over the most ethical approach to take.
“Ethics services, like all other services in healthcare, need to be open to opportunities for improvement. Mature ethics programs engage in quality assurance activities of various kinds,” says Ann Munro Heesters, MA, PhD, senior director of clinical and organizational ethics at University Health Network. Here are some common misconceptions clinicians have about ethics consults:
Ethicists will undermine clinicians’ authority. “This view sometimes persists, even if ethicists insist that clinical decision-making always remains in the hands of clinicians, patients, and substitute decision-makers,” says Heesters.
The purpose of an ethics consult is to affirm the clinical team’s recommendation. “If a consult requester thinks that an ethics consult is ultimately just a rubber stamp to enforce what the team wants, then naturally they will find ethics consults unhelpful when this does not occur,” says Jordan Potter, PhD, HEC-C, director of ethics at Community Health Network in Indianapolis. Clinicians may expect that the ethicists will override a patient’s wishes, for instance.
Ethics consultation notes, which ordinarily become part of the official patient record, can be helpful in promoting transparency. “Rendering the ethicist’s reasoning explicitly can counter the charge of arbitrariness,” says Heesters. For example, ethicists can name the ethical principles at work or reference policies, legislation, or canonical cases. This makes it clear to clinicians that a recommendation was not just based on the ethicist’s opinion.
Ethics consults are overly time-consuming and will slow down the care process. There can be some truth to this perception, since ethics consults are not always quick. “A good ethics consultation practice sometimes requires the ethics consultant to slow things down to gather the relevant information needed to make a sound ethical recommendation,” says Potter. Ideally, ethicists can be reached around the clock very quickly via pager or cell phone. Some ethical questions can be resolved in just a few minutes, such as how to identify an incapacitated patient’s legally authorized decision-maker. Other questions, such as how to resolve a serious end-of-life conflict, may take somewhat longer to resolve.
“But they may not be excessively time-consuming for an ethicist who knows the values of the parties involved, and how such cases are ordinarily navigated at the institution,” says Heesters. Cases involving multiple parties and cases that require mediation expertise because the team has reached an impasse or there is a genuine value conflict tend to take the most time. In those cases, ethicists must follow a process to establish or restore trust between the conflicting parties. “It is unlikely that the ethicist will know upfront how long a consult will take. Many cases are not primarily about the presenting issue, and it takes some effort to unravel complexity,” Heesters explains.
Ethics consults are requested because someone is behaving unethically, with ethicists functioning as the so-called “moral police.” Clinicians may suspect that a colleague contacted ethicists for a punitive or retaliatory purpose. “This is a particularly problematic negative perception, which is a detriment to the reputation of the ethics consultation service,” says Potter.
Ethicists can counter this perception by explaining to clinicians how their role differs from a compliance or disciplinary function. For instance, ethicists can explain that their role is to bring clarity where there is uncertainty, or to help identify ethically defensible options in complex, difficult cases. Ethicists also can refer clinicians to the correct hospital department if a request is not in the purview of ethics. “If someone is behaving in a manner that violates professional standards, or in an unlawful, abusive, or fraudulent manner, that is a matter better taken up by legal, medical affairs, or human resources,” says Heesters.
Some ethics programs follow up on consultations by surveying participants. “Surveys are not always a good way to assess the value of the ethicist’s contributions,” cautions Heesters. This is because the most ethically defensible outcomes will not satisfy people who wanted a different outcome.
A quality ethics consult could appropriately determine that the team has an ethical obligation to honor the patient’s known wishes for continued aggressive treatment, for example. However, a clinician who requested an ethics consult hoping to set treatment limitations for concerns about the patient’s quality of life would be unhappy with that result. Additionally, there are concerns about response bias with surveys. Most responses tend to come from people who were either extremely satisfied or dissatisfied with the ethics consult. “Any post-consult survey must be carefully developed to address these concerns,” says Potter.
Survey questions can yield some important data, however. Participants can offer some valuable input on the timeliness of the response, whether the ethicist clarified important concepts, and whether the ethicist treated all parties with respect, says Heesters. “There are ways to send surveys via email or mail with the consent of those with standing in the case. It would be important to protect the anonymity of those who wish not to be identified by their responses,” adds Heesters.
Ethics services can take a broader view, and seek feedback from other areas of the hospital, to learn more about how they’re perceived. “Some institutions have advisory boards that provide advice and input from diverse constituencies, which generally include clinicians, patients, and caregivers,” says Heesters.
Ethics programs can communicate their role via brochures, webpages, and educational materials. “The best antidote to negative perceptions, however, is experience working directly with an ethicist or ethics team,” according to Heesters.
Ethicists must demonstrate quality, competence, and helpfulness to medical teams if they want to truly counter negative perceptions. “That should always be the first step: Making sure that you are providing a quality, helpful service that is responsive to the medical team’s needs,” says Potter.
To encourage more realistic expectations of a consult, ethicists should make sure that medical teams understand these two things, advises Potter:
- what an ethical dilemma is;
- how an ethics consult can help support clinicians in resolving that ethical dilemma.
“If I know that a specific unit or team member has a negative perception of the ethics consultation service, I aim to explicitly address this with them,” says Potter. That might entail a face-to-face discussion with the individual themselves or a conversation with leadership on a unit. Sometimes, Potter provides a brief, tailored education session on the ethics consultation service and how it can support a specific unit.
Informal word-of-mouth might be the best way to find out how consult requestors perceive ethicists, however. Most ethicists have additional clinical roles at their institutions and are colleagues with the clinicians they serve as part of their ethics role. “Folks are rarely shy about telling us what they need from us or about the changes they would like to see,” says Heesters.
Reference
1. Weiss Goitiandia S, Axelrod JK, Batten JN, Dzeng E. Hospital ethics committees and consultants: How do clinicians perceive their utility in resolving disagreements about life-sustaining treatments? Am J Bioeth. 2025;25(3):81-85.
Ethicists work hard to make sure that all stakeholders in complex cases are heard. Yet, when the consultation is completed, ethicists usually do not know how the clinical team feels about the process.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content