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Clinical Consultation

REQUESTING A CLINICAL ETHICS CONSULTATION    

Who?   Ethics consultations may be requested by any member of the health care team.  As a matter of courtesy, the attending physician of record is notified.

What?   Clinical ethics consultations are interventions by trained members of the Bioethics Advisory Committee to help resolve an ethical dilemma or answer an ethical question that arises in the course of patient care. The consultation is purely advisory.  Bioethics Advisory Committee members and consultants have no authority to make patient care decisions. Patients and their insurers are not charged directly for ethics consultations. 

The process consists of these steps:

• Consultants review medical records and interview the patient, physicians, nurses, family members, surrogate decision makers, and other relevant parties.
• They provide an analysis of the ethical issue and suggest means to resolve it. This may include a face-to-face meeting with all parties.
• The primary consultant dictates a progress note with recommendations that is added to the patient's record.
• The case is then presented to the full Bioethics Advisory Committee at its next scheduled meeting and discussed. 
• Follow-up is often performed.

When & Why?   Ethics consultations may be appropriate when a clinical-ethical dilemma arises in the course of patient care. The most common issues prompting clinical ethics consultations are:

• A conflict between the medical and nursing staffs over the best care of the patient.
• A conflict between the medical-nursing staff and the family over the best care of the patient.
• Evidence that the medical staff is not following the wishes of the patient or surrogate.
• Evidence that the family or surrogate decision maker is making a decision that is not in the patient’s best interest.

Ethics consultations are not appropriate for primarily legal or financial questions, or for allegations of professional misconduct.  The former questions can be addressed to Risk Management; the latter to the Code of Professional Conduct Advisory Panel.

How?   The chair of the Bioethics Advisory Committee Consultation Subcommittee, Dr. Diane M. Palac, can be reached by phone, e-mail, or page.  When she is unavailable, the following Consultation Subcommittee members may be contacted, in this order: 

Diane Palac, MD:	(603) 650-7365,	pager 2295
James L. Bernat, M.D.:	(603) 650-6279,	pager 2349
Peggy Plunkett, APRN:	(603) 650-5939,	pager 5939
Kate F. Clay, R.N.:	(603) 650-5578,	pager 5578
Patrick McCoy, Chaplain:	(603) 650-7940,	pager 9862
Cathy Mabie, M.S.W.:	(603) 650-5795,	pager 5795

The hospital operator and the administrative officer on call have access to the ethics consultants contact list for emergency ethics consultations after hours.