Clinicians are using a trauma-informed care approach in many different settings.1-4 Some ethicists are considering how to use this approach for consults.5 “Many ethicists, regardless of background or discipline, already perform ethics consults in ways that align with aspects of trauma-informed care,” says Elizabeth Lanphier, PhD, MS, assistant professor in the Ethics Center at Cincinnati Children’s.
Some ethicists have been trained in trauma-informed care — more likely if they also are physicians, nurses, or social workers. Nonetheless, “it is not currently part of standard approaches to clinical ethics training or practice,” says Lanphier, who co-authored two recently published papers in which she and a colleague argued clinical ethics consultation services should add trauma-informed awareness and training.6,7
Ethics consults often center on traumatic situations — for patients, families, and even the clinicians who are providing treatment. “Trauma-informed care transforms questions about what is wrong with someone to wondering about what is going on for them or what happened,” Lanphier says.
Ideally, trauma-informed care is integrated throughout an organization’s policies and practices. “More health systems and hospitals are adopting trauma-informed care not only in specific units, but ideally across their institutions,” Lanphier reports.
That includes the ethics service. “Additionally, we see trauma-informed care as an important tool in the ethicist’s toolbox to further social justice aims,” Lanphier says.
To adopt a trauma-informed approach, Lanphier says ethicists can become aware of the prevalence of trauma and learn to recognize signs and symptoms. This way, ethicists could adopt trauma-informed practices for all cases as a universal precaution.
“Trauma-informed practices reflect key principles in trauma-informed care,” Lanphier says.
Those include physical and emotional safety; empowerment and inclusion; transparency; leveling hierarchy; fostering voice and choice; paying attention to bias, stereotypes, and exclusion; and seeking opportunities for peer support. During consults, ethicists routinely demonstrate this approach by identifying all stakeholders and soliciting their input. “That supports inclusion and collaboration,” Lanphier adds.
Also, most ethics services maintain a best practice of taking consults from anyone involved in a patient’s care, including all roles in a care team, along with patients and families.
“While leveling hierarchy can be challenging in healthcare, ethicists often work to make sure each voice and perspective relevant to a consult is included, not only those traditionally at the top,” Lanphier explains.
All these practices align with a trauma-informed care approach. Even so, Lanphier says there are benefits to providing specific trauma-informed training to clinical ethicists. It is a way to ensure trauma-informed practices are consistently applied. “Internalization of trauma-informed principles, making them habit, and engaging them as a universal precaution can be made routine,” Lanphier offers.
REFERENCES
1. Nagle-Yang S, Sachdeva J, Zhao LX, et al. Trauma-informed care for obstetric and gynecologic settings. Matern Child Health J 2022;26:2362-2369.
2. Arya S, Zutshi A. Trauma-informed care in the neonatal intensive care unit: Through the lens of the COVID-19 pandemic. Cureus 2022;14:e30307.
3. Brown T, Ashworth H, Bass M, et al. Trauma-informed care interventions in emergency medicine: A systematic review. West J Emerg Med 2022;23:334-344.
4. Duffee J, Szilagyi M, Forkey H, et al. Trauma-informed care in child health systems. Pediatrics 2021;148:e2021052579.
5. Sankary LR, Morley G, Ford PJ. Trusting the ethics consultant: Adopting a trauma-informed approach to ethics consultation. Am J Bioeth 2023;23:101-103.
6. Lanphier E, Anani UE. Enriching the theory and practice of trauma informed ethics consultation. Am J Bioeth 2022;22:W7-W9.
7. Lanphier E, Anani UE. Trauma informed ethics consultation. Am J Bioeth 2022;22:45-57.
Ethics consults often center on traumatic situations — for patients, families, and even the clinicians who are providing treatment. Trauma-informed care transforms questions about what is wrong with someone by adding more context, such as discovering information about what happened to the patient.
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