Telehealth initiatives for clinical areas have been expanded to clinical ethics consultations in some healthcare settings. Investigators recently analyzed two virtual clinical ethics consultation services.1
The authors studied the Johns Hopkins Hospital’s Ethics Committee and Consultation Service and a Malaysian ethics consultation service. Both platforms improved the ability of local practitioners to obtain ethics consults who otherwise would be unable to. Both allowed ethics consultants to share expertise and collaborate.
“We also found similar challenges to implementation of virtual clinical ethics consultation across these two very different clinical settings,” reports Eman Mubarak, BS, the study’s lead author and a former predoctoral clinical ethics fellow at the University of Michigan Center for Bioethics and Social Sciences in Medicine.
Both programs resulted in less personalized communication between patients and providers. There also were some technical issues, along with logistical and operational concerns.
Mubarak and colleagues would like to see their findings used to expand accessibility to virtual clinical ethics consultation across patient populations and health systems around the globe. “Sustainable development of virtual consultation platforms, funding, training of ethics consultants, and visibility of virtual clinical ethics consultation are priorities,” Mubarak says.
Some ethicists gained experience with remote ethics consults before the COVID-19 pandemic. Barrie J. Huberman, PhD, HEC-C, tried tele-ethics for the first time in 2016. The facilities at the health system where Huberman was employed were far apart geographically.
This prevented ethicists from timely handling cases. The experience demonstrated remote ethics consults could be effective.
“It’s possible to use tele-ethics really well, even in highly complex cases,” says Huberman, now clinical director of medical ethics at Weill Cornell Medicine in New York City.
Huberman was considering integrating tele-ethics into the consultation process at Weill Cornell when the pandemic accelerated the use of remote consults.
“The objective was — and still is — to preserve the consult process at a very high level, including patient visits [and] team and family conversations,” Huberman reports.
Weill Cornell’s ethicists learned high-quality ethics consultations and meaningful encounters can be conducted remotely. The ethicists now use a hybrid approach — face-to-face communication combined with remote meetings when it makes sense. Ethicists usually see patients in person, but team meetings and other deliberations are mostly remote.
Multidisciplinary teams and clinical ethicists discuss their encounters with patients and families, and deliberate the issues together in the same thoughtful manner, regardless of whether they are together physically.
“This mixed model is ideal, even in the most complex cases,” Huberman offers. “There is no question there’s an efficiency to it, but we don’t sacrifice process or quality for it.”
Remote meetings allow the ethics service to handle more volume and pull in individuals as needed, such as hospital attorneys, interpreters, or family members who live far away. “The culture in our organization is that ethics has a convening power to bring people together for discussions about cases,” Huberman explains.
Those meetings usually are remote, cutting down on time demands for overworked clinicians. For example, an ICU nurse might be reluctant to leave the unit to go sit in a room for an hour, but the nurse could be willing to participate in a remote consult for a short time.
Many meetings of all types in hospitals have remained remote. Thus, remote clinical ethics work reflects the way other clinical areas are operating. Remote meetings enable stakeholders to meet unmasked, to see each other in a way that is not always possible in the hospital.
“We’ve all learned to respect each other’s time, by moving quickly through a meeting together in an electronic space, yet making it very high-touch,” Huberman reports.
Ethicists take a cue from stakeholders on whether meetings happen in person or remotely. Many families greatly appreciate the opportunity to participate in remote meetings because they cannot take off from work or struggle to travel to the hospital. If a family member prefers to meet in person, then such a meeting will be arranged.
Sometimes, other factors make it apparent that an in-person meeting is needed. For example, if a patient is cognitively impaired, it might be possible to engage with the patient remotely, but might be ideal to visit the patient at bedside to ensure the person is heard and understood. Generally, Huberman says the remote consults are just as effective as in-person consults.
“At the end of the day, it’s about creating instant intimacy, respectful listening, and communication,” Huberman says. “That’s what it’s always been about, whether you are sitting together in a room or not.”
REFERENCE
1. Mubarak E, Kaur S, Min MTK, et al. Emerging experiences with virtual clinical ethics consultation: Case studies from the United States and Malaysia. J Clin Ethics 2023;34:51-57.
Sustainable development of virtual consultation platforms, funding, training of ethics consultants, and visibility of virtual clinical ethics consultation are priorities.
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