Clinical Ethics

I spent my elective time working with the clinical ethics service at our hospital. Few people are aware of the ethics consult team; I think I was probably a couple years into residency when I learned who they are and what they do. In fact, most large hospitals have a clinical ethics consultation service. Modern medicine can involve so many complex decisions, moving parts, uncertainty, decision-makers, and competing interests that occasionally, situations arise where the right thing isn't completely clear. A patient with near-certainty of death has a family who wants everything done. An unidentified trauma victim has nobody to make decisions on his behalf. A committee has to decide how to allocate organ donation. A parent demands treatment for her child based on irrational fears. The scare of Ebola asks how much danger we expose our practitioners to in the care of potentially infected patients? How do we navigate these situations? How do make sure we aren't violating any ethical (or legal) principles? How do we justify the decisions we make?

The ethics committee at Stanford is a multidisciplinary committee co-chaired by a physician and a non-physician (a PhD ethicist). It consists of physicians of different specialists, nurses, residents, therapists, community laypersons, and community physicians. When we are called for an ethical dilemma, we examine all the various factors playing into the situation, from medical facts to achievable goals to patient (or surrogate's) desires to quality of life. We work very closely with the palliative care consultation team, and occasionally with risk management (the legal team) to ensure a comprehensive look at the problem. We meet with the patient, the family, the medical team, and the consultants. And hopefully, we provide an objective, ethics-centered way to navigate the dilemma. Sometimes, it is a simple as backing up and supporting the medical team (ie. a second opinion). Other times, we have to examine the law and policy to determine whether an intervention is appropriate. Each case is individual and different, and spending several weeks with the ethics team taught me a lot about how to think about cases in this related but nonmedical framework.