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Clinical Ethics

URMC / Clinical Ethics / SMH Consult Service

Consult Service

Choices about patient care always involve values, and a discussion of the patient's and doctor's values may help both to make their decisions.

The Ethics Consultation Service helps patients, families, and caregivers to navigate the issues and choices surrounding difficult decisions.

Ethics consults aid decision making in complex situations; they are most often not a sign of "failure" or moral lapses.

Most cases involve one of the following:

Unclear treatment goals

  • How to decide among several reasonable treatments?
  • Is the treatment offered against the patient values?
  • Is treatment requested not usual medical practice?
  • Is there a difference of opinion which treatment is most desirable for this patient at this time?

Uncertainty regarding decision-making roles

  • Who is the rightful decision maker?
  • How should the person make the decision?
  • Does the patient have the capacity to make this decision?
  • What if there is disagreement about the best decision?

Assistance in conflict resolution

  • Between providers and family/patient
  • Within a family
  • Within or between treatment teams
  • Within a person (who is ambivalent or in denial)

Any member of the healthcare team, patient, or family can request an ethics consultation.

Attending physicians, residents and fellows, nurses, technicians, therapists, social workers, and others involved in a patient’s care may request an ethics consultation.

The requestor’s name can be kept confidential, but the medical attending of record will be notified that an ethics consultation has been called about his patient.

A consultation is typically arranged by the attending physician or another member of the healthcare team, although patients, family members, or others may contact the Service directly. A formal consultation involves meeting with the patient and family and/or friends, and discussions with the attending physician and other members of the healthcare team. The Ethics Consultation team writes a consult note which assesses the particular ethical issues and makes recommendations for resolution; this note is included in the patient's chart.
 
This service is financed by the hospital at no cost to the patient.

Medical students who choose to do an elective in Clinical Ethics will have an opportunity to work on this Service and participate in all its activities.