By Stacey Kusterbeck
Core competencies for ethics consultation were established in 2011 by the American Society for Bioethics and Humanities (ASBH).1 However, it is unclear if ethics consultants are consistently meeting these standards. “Most of the standards are not supported by empirical data, but many do reflect expert consensus. Integration of more of these standards may allow for modest improvements in ethics consultation practice, if implemented in sustainable ways,” says Jennifer K. Walter, MD, PhD, MS, director of the Department of Medical Ethics at Children’s Hospital of Philadelphia.
Ethics consults had only moderate adherence to the ASBH standards, according to a 2022 survey of 600 hospitals.2 Ethics consult practices at those hospitals had high (more than 75%) adherence to only three of 12 ASBH standards. However, only adult hospitals were included in the study sample. Walters and colleagues conducted a study to look at adherence to ASBH standards by pediatric ethics consultation teams.3 “We wanted to raise awareness about the ASBH standards and also encourage individual groups to thoughtfully consider which elements of the standards are most meaningful to their practice environment,” says Walter.
The researchers surveyed 104 pediatric ethics consultants at children’s hospitals in 45 states. Adherence rates for pediatric ethics consultation were similar to those found at the adult hospitals. “The areas that are probably agreed to be the most foundational had the best adherence,” says Walter. These areas were high-adherence:
- At all the hospitals, all staff members, as well as patients and families, were allowed to request an ethics consult.
- Seventy-seven percent of hospitals had at least one individual with advanced ethics consultancy proficiency available.
These areas were low adherence:
- Documentation of ethics consults. About one-third (32%) of respondents reported always documenting a brief note in the electronic medical record.
- Only 12% of hospitals had a formal response plan for egregious ethics violations (such as notifying supervisors or oversight bodies).
- Only 17% of hospitals had a formal process to receive feedback from people who had requested ethics consults.
- Only 8% had comprehensive policies covering all aspects of ethics consult activities (who can request a consult, roles and responsibilities of ethics consultants, which requests are appropriate or inappropriate, the steps involved in an ethics consult, how ethics consults are documented, and who is accountable for the quality of ethics consults). In contrast, 56% of adult hospitals in the previous study reported having a comprehensive policy.
“Given the limited resources of most ethics consultation programs, it seems most groups are prioritizing access to consultation over more burdensome tasks,” suggests Walter.
Not all ethics services have the resources to undertake writing a comprehensive hospital policy or implementing a feedback mechanism. However, those practices are important to improve standardization and the quality of ethics work. “While it is understandable that those practices are not possible by most small teams, the inability to perform these tasks will also prevent the field’s ability to demonstrate value — which may result in more funding for its work,” says Walter.
Not every ethics program can meet all ASBH standards all the time. Regardless, ethicists can benefit from reflecting on why they are not able to do so. “If some of the limitations are due to a lack of resources, these standards can be offered as a reason to leaders to provide more resources to pediatric ethics consultation groups,” offers Walter.
References
- American Society for Bioethics and Humanities. Core Competencies for Healthcare Ethics Consultation. 2nd ed. American Society for Bioethics & Humanities; 2011.
- Tarzian A, Fox E, Danis M, Duke CC. Ethics consultation in U.S. hospitals: Adherence to national practice standards. AJOB Empir Bioeth. 2022;13(1):10-21.
- Arango H, Gramszlo C, Grewal J, et al. Ethics consultation in U.S. pediatric hospitals: Adherence to national practice standards. AJOB Empir Bioeth. 2024 Dec 5:1-8. doi: 10.1080/23294515.2024.2433473. [Online ahead of print].
Core competencies for ethics consultation were established in 2011 by the American Society for Bioethics and Humanities. However, it is unclear if ethics consultants are consistently meeting these standards.
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