Ethics Advice and Resources for Clinicians

Office of Clinical Ethics Resources

• BWH Ethics Committee

General Resources

• Advance Care Planning Resources
• Bioethics Briefing Book (The Hastings Center)
• Discussing Prognosis with Patients
• Patient Education Pamphlet about Brain Death

The Ethics Consultation Service

The Ethics Consultation Service (Ethics Service) is a multidisciplinary service that provides consultation and staff education in situations of ethical conflict and stress. The Ethics Service is staffed 24/7 by members of the hospital’s Ethics Committee and provides ethics consultations for all BWH clinicians as well as any BWH patient or family member of a patient.

What the Ethics Service Can Do To Help

Weighing the benefits and burdens of treatment or identifying which treatment is right for each patient can be challenging – particularly with the multitude of choices and technological advances facing clinicians and patients today. Conflicts can arise based on differences in values, difficulties in communication, or due to the severe stress of critical illness. In these situations an ethics consultation can be helpful.

Ethics consultants help to clarify and resolve ethical issues that can often be at the root of medical decision-making conflicts or confusion. This process can involve reviewing the patient’s medical record, meeting with the patient and family and facilitating discussions among caregivers and family. A summary of the consultation is recorded in the patient’s chart.

The consult team is not a decision-making body. While ethics consultants often make recommendations, decision-making authority rests with the clinicians, patient, and family.

Below are examples of situations in which an ethics consultation can be helpful:

• Facilitate discussion of differences of opinion among caregivers and/or family members about treatment
• Support a patient or family member in making decisions about what type of care the patient should receive or the goals of that care
• Facilitate discussing end-of-life decision making
• Educate patients, families, and staff on hospital policies affecting patient care, such as resuscitation or life saving treatments
• Work with patients, families, and staff to help include personal values, religious, and cultural traditions in decision making
• Address questions about a patient or proxy’s ability to make decisions about treatment (proxies are people who are appointed to make decisions for patients who cannot do so for themselves)
• Address concerns about possible limitations on care set by an insurer or third party payer

The Ethics Committee

The Brigham and Women’s Hospital Ethics Committee is a multidisciplinary advisory group comprised of physicians, nurses, social workers, administrators, clergy and representatives of the community. The Committee meets semimonthly with the following goals:

• To provide a peer review forum for recent ethics consultations
• To educate Committee members about the principles and clinical applications of bioethics
• To develop new (or revise existing) hospital policies and procedures that relate to ethics and patient care

Committee members who are not actively involved in the Ethics Consultation Service generally serve a three-year term. This rotation of staff from various departments provides a mechanism for integrating bioethics education throughout the hospital.

The Ethics Management Group, a subgroup of the larger Committee, meets on a monthly basis to develop Ethics Committee meeting agendas and create an integrated bioethics curriculum across Committee meetings.