Representing Patients

One situation when an ethics consult is required is the case where a patient is unable to make decisions for himself and has no one to make it on his behalf. It's fairly rare, and pretty sad when we a patient in this situation, but it happens. An immigrant whose relatives we have not been able to reach has a stroke and is in a coma. A homeless man comes in with a rampaging infection and needs surgery. While a procedure or surgery can be done emergently if someone's life depended on it, other more nuanced decisions need a decision-maker. We feel that patients with no representative are some of the most vulnerable, and as a result, we mandate an ethics consultation in the case of any decisions that normally would require a patient or surrogate's consent. That way, we don't have unquestioned medical decisions. From the ethics team, we've consented for blood transfusions, surgeries, and changes in the care plan for patients who cannot communicate their wishes and have no family or friends to speak for them. We hope that this way, we do the right thing for all of our patients.