Ethics Consult Requestors Will Expect Quick Response
April 1, 2025
By Stacey Kusterbeck
When someone reaches the point where they are contacting an ethicist, it is safe to assume that person has, at least in their minds, a very pressing concern. “Often, folks need an answer right then and there,” says Parker Crutchfield, PhD, professor of medical ethics, humanities, and law at Western Michigan University Homer Stryker MD School of Medicine.
Sometimes, it is life or death — a treatment decision has to be made within the next few hours. Clinicians may be calling because a patient lacks decision-making capacity and wants to leave against medical advice or because a frail patient is about to be discharged to a very unsafe environment. The people involved simply cannot wait until the next day to hear what the ethics committee has to say on the matter. “Whatever the situation, there has to be a mechanism to respond quickly,” says Crutchfield.
But what response time is quick enough for ethics consult requests? There is no clear consensus. “At some institutions, the standard is to get back to someone within 24 hours. That’s not good enough,” says Crutchfield.
In Crutchfield’s experience, delayed response times are more likely when ethics input is team-based. If multiple people have to come to a consensus on a recommendation, it is going to take longer. “This usually happens when there is no well-defined expert in that group — someone who is highly trained, with a terminal ethics degree, who is comfortable taking ownership. Instead, it’s people with minimal training or a passing interest in ethics, but no in-depth training,” says Crutchfield.
Ethics resources vary widely at institutions in terms of availability and expertise. However, any ethics program, regardless of the circumstances, has to have a mechanism to respond rapidly, emphasizes Crutchfield.
At WMed Health, ethicists respond within an hour, 24 hours a day, seven days a week. Many clinical ethicists teach in addition to performing ethics consultations, but this does not prevent them from meeting the one-hour timeframe. Normally, though, ethicists respond much more quickly. “We informally require a response within 15 minutes. And, usually, I would say we respond within three minutes,” says Crutchfield.
All ethics consult requests are made through a paging system, which goes right to the cell phone of one of three ethicists who are on-call rotating weeks. In contrast, emails or voicemails do not allow for immediate responses. “There’s got to be a good way for ethicists to communicate quickly. Otherwise, it’s not going to foster a healthy clinical ethics service. Not being able to respond quickly, and in all contexts, undermines the ability to offer a coherent, functioning ethics service at all times,” says Crutchfield.
Some healthcare providers are surprised to hear back from an ethicist so quickly. “Some have said, ‘I didn’t even think you’d call back.’ Hopefully, I responded in such a way that they no longer think that,” says Crutchfield.
At Johns Hopkins Hospital Ethics Committee and Consultation Service, a consult team leader responds to all incoming requests, with ethicists taking on the role on a rotating basis. The expectation is that the team leader will respond to the request within 15 minutes. “The means to request consults has changed over time,” says Mark Hughes, MD, core faculty at Berman Institute of Bioethics.
Not long ago, consult requests came to ethicists through a numeric pager. Next, ethicists switched to an online messaging application that sent a text message to the pager of the on-call ethicist. Recently, the process was changed again, with requests coming in via Secure Chat through Epic. “Because we permit all members of the healthcare team to request an ethics consult, we have not gone the route of using an order placed in Epic, which is only available to authorized prescribers,” explains Hughes. Patients and/or their representatives can page the pager, call the administrative office and leave a message, or ask a member of the clinical team to request the consultation on their behalf. Team leaders receive consult requests on their mobile phones.
“The main impediment to timely response to a consult request is that the team leader may be in a meeting or busy with clinical responsibilities,” says Hughes. With Secure Chat, team leaders can send a text message stating that they cannot respond immediately but will contact the requester when they are free.
Together, the ethics team leader and requester determine when a mutually convenient time can be arranged with all stakeholders. The team leader confers with the rest of the ethics team members to learn their availability. “It is rare that there are ‘ethics emergencies’ when a meeting needs to be convened within hours,” says Hughes. Most meetings happen within two days. “The hospital has a policy on ethics consultation that sets expectations. These are reinforced when the ethics team leader speaks with the requester,” says Hughes.
When someone reaches the point where they are contacting an ethicist, it is safe to assume that person has, at least in their minds, a very pressing concern. But what response time is quick enough for ethics consult requests? There is no clear consensus.
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