Clinical Ethics Consultation

The Clinical Ethics Consultation Services (CECS) is the clinical service arm of the Center for Healthcare Ethics. Staffed by Center faculty, the primary purpose of the CECS is to promote and enable morally appropriate and effective decision-making by those primarily involved in patient care situations. To achieve this purpose, clinical ethics consultants maintain four objectives when interacting with others:

  • To discuss relevant facets of each situation with all participants directly involved, to promote good communication and understanding of the issues, alternatives, decisions, and likely outcomes
  • To assist participants in identifying the ethical values and goals associated with each situation
  • To enable clear understanding of each person's basic moral framework and its impact on decisions and outcomes
  • To help resolve problems, conflicts, or dilemmas related to the ethical values and goals associated with each situation, including each person's own basic moral framework

Who Can Make a Request?

Any individuals primarily involved in a patient's care may request the CECS.

  • Patients
  • Family/patient's legal representative
  • Physicians (staff, residents, students)
  • Nurses
  • Social workers
  • Etc

Requests may be made by calling the Center for Healthcare Ethics' ethics consultation hotline, 310-423-9634 or by sending us an email ethics@cshs.org or by directly contacting: 

Dr. Stuart G. Finder, Ph.D.
Director
310-423-9639

stuart.finder@cshs.org

Dr. Virginia L. Bartlett, Ph.D.
Assistant Director
310-248-8199
virginia.bartlett@cshs.org

Dr. Kenneth Leeds, MD
Associate Director
310-423-9636

kenneth.leeds@cshs.org


Typical Reasons For Requesting Ethics Consultation

Ethics consultation may be requested whenever an individual directly involved in a patient's care believes there to be an issue or concern of ethical import. In general, this is often due to differences regarding the norms to be used when making decisions about what is right, good, or fair in a specific circumstance. While not meant to be definitive or exclusive, below are some of the more common considerations, which prompt requests for ethics consultation:

  • Concerns associated with end-of-life treatments (code status, advance directives, withholding/withdrawal of medical interventions, etc)
  • Questions regarding surrogate decision-making
  • Determining "appropriate" levels of intervention
  • Patient refusal of treatment
  • Real or perceived conflicts between and among patient, family, physicians, nurses, etc.
  • Permissibility of using innovative or controversial treatments
  • Moral distress of patient, family, or care providers

Attending physicians, consultants and assigned nurses are invited to attend. Any or all family members are invited as well as friends, clergy or advisors who might add to the discussion.

What Happens Once Ethics Consultation is Requested?

General Information

  • Ethics Consultant meets with the requester to begin assessing the situation and determining possible further steps.
  • Ethics Consultant may review patient's medical record.
  • If substantive issues at stake, Ethics Consultant may engage in individual or group discussion with others involved in the patient's care.
  • Formal care conference may be arranged.
  • Specific recommendations and entries into the patient's medical record may result.


When a request for Ethics Consultation is from a patient or family/legal representative

  • Attending physician informed of request in timely fashion and kept informed of substantive developments.
  • Explanation of hospital policy provided if needed.
  • Substantive discussion with attending physician, other healthcare providers pursued if necessary.
  • Facilitation of communication with others involved in patient's care offered.


When a request for Ethics Consultation is from a Healthcare Provider

  • Ethics Consultant meets with the requester to begin assessing the situation and determining possible further steps.
  • If the requester is other than the attending physician, if warranted, ethics consultant may contact attending physician to solicit information and offer assistance.
  • Explanation of hospital policy provided if needed.
  • Facilitation of communication with other healthcare providers involved in patient's care offered.
  • Substantive discussion with attending physician, other healthcare providers pursued if necessary.
  • Conversation with the patient/family/ legal representative pursued only after discussion with attending physician.
  • Ongoing conversation with the requester continues throughout unless otherwise refused.

Documentation of all requests for ethics consultation as well as all related clinical activities of ethics consultants are maintained in secured files located in the Center for Healthcare Ethics.