Week 2: Consultation Flashcards
what is a clinical ethics consultation
a service provided by an individual consultant, team or committee to address the ethical issues involved in a specific clinical case. Its central purpose is to improve the process and outcomes of patient care by helping to identify, analyze and resolve ethical problems
- unbiased perspective
- usually has an outcome
- involving all stakeholders
ASBH defines 3 main strategies for ethics consultation:
- authoritarian (not seen in Canada)
- pure consensus - must bring everyone together on the same page
- no decision = a decision - ethics facilitation (most common in Canada)- takes all the facts and facilitates a dialogue
The Office of Health Ethics (OHE) provides:
“values-based” decision support, education, and analysis to patients and families, trainees, staff, leaders and investigators to promote ethical decision-making
- appeal to both values and facts
- moral distress constructs
- enable intentional deliberation focused on how values are incorporated into clinical and organizational decisions
the OHE effects change by influencing LHSCs cultural norms towards:
- recognizing and routine discussion of ethical concerns
- addressing ethics issues ona. system level
- empowering and modelling ethical behaviours
- endorsing transparency
- promoting robust stakeholder analysis and inclusion
The OHE does not:
- does not make ethical decisions for organizations or individuals
- Just because the OHE was involved in a case or discussion does not mean that the final decision was ethical or the “right” one
- role may be to provide guidance, facilitate discussion, or analyze ethical aspects, but they do not serve as a stamp of approval
OHE Goals:
- appretiates value of eithcs
- discusses ethical concerns
- seeks ethical resources when needed
- works on a systems level
- feels empowered to act ethically
- organizational decisions = ethical
Ethics Consultation
Questions Process: Did a framework guide decisions?
- how are decisions being made?
- what information is relevant to decisions?
- what stakeholders should be engaged?
- which perspectives should/should not be considered?
- is information missing?
- how were the options available?
Some of the most common outcomes:
- safety risks (patient and staff)
- psychological risks (patient and staff)
- college risks for regulated professionals
- clinical outcomes
- moral distress outcomes
- legal outcomes
- organizational outcomes
Who can acess Ethics consultations?
- available to anyone
- aligned to specific programs
- urgent consults via pager (on-call ethicist available 24/7)
- patients and families can call the board or send an email
identifying an ethical issue:
- an “icky” feeling
- running an extra KM to distress
- emotionally “sliming” others
- feeling ‘numb’ to an issue that used to bother you
- low impact disclosure
low-impact disclosure
low-impact disclosure might involve sharing non-sensitive patient data (e.g., general statistics without identifying information).
VALUES FRAMEWORK:
Voice your concerns
Assess ethics resources
Learn about the issue
Understand differing perspectives
Evaluate the options
Sustain the learnings
FOUR BOX MODEL
- Medical indications
- Patient preferences
- Quality of life
- Contextual features
(1) Medical Indications
diagnostic and therapeutic interventions that are being used to evaluate and treat the medical problem in the case
Patient Preferences
state the express choices of the patient about their treatment, or the decisions of those who are authorized to speak for the patient when they are incapable of doing so
Quality of Life (QL)
degree of satisfaction, pleasure and well-being or the degree of distress and malfunction that people experience in their life before and following treatment
Contextual Features (CF)
identify social, institutional, financial and legal settings within which any particular case of patient care takes place
The principle of Noncontradiction
logical and ethical necessity that ethical decisions, policies, and justifications should not contradict themselves
*cant say that the sky is blue and purple
- deductive arguments use premises to prove a conclusion
- if all the premises are true then the conclusion must also be true
- two positions cannot logically coexist
- justifications must be based on logical reasoning
- personal perspectives cant overpower wishes or policies
Example:
FAULTY PREMISE
Nick Jonas is a musician
Nick Carter is a musician
All persons named nick are musicians
= my cousin Nick must also be a musician
(third statement is not true so we reject this) - can be proven to be faulty
a demonstration is deductively valid if:
anyone who affirms the premises but denies the conclusion would be caught in a contradiction
a demonstration is deductively invalid if:
anyone who affirms the premises can deny the conclusion without contradicting themselves
Patient A has a medical condition
This condition can be easily treated
if A declines treatment they will die
A is declining treatment
the second premise can be rejected
- what does “easy” mean?
- can use the term “medically treated” instead
Ladder of Inference
- Observable data
- Select data from what I observe
- Add meanings
- Make assumptions
- Draw conclusions
- Adopt beliefs
- Take actions based on my beliefs
what is a cognitive bias?
systemic errors in reasoning are caused by subjective perception of reality
- predictable patterns of error in how the brain processes information, and as such are widespread
- difficult to avoid
issue with holding on to beliefs:
once we adopt beliefs that we are holding onto, we strongly attach to them
- it can be hard to change them
polarization and division
a product of (or related to) a “hidden bias” of belief or fact
- assumptions we have unknowingly made to support our reasoning can often confound the decisions we make
measuring outcomes in clinical ethics: Ethicality
the degree to which clinical practices conform to established standards
- no clear way to measure this
measuring outcomes in clinical ethics: conflict resolution
the degree to which parties involved in a consult that features a conflict in values or opinion perceive that the conflict has been appropriately resolved
measuring outcomes in clinical ethics: satisfaction
a subjective assessment of participant experience with ethics consultation
measuring outcomes in clinical ethics: education
the acquisition of new knowledge or capabilities through instruction or experience
