Ethics Consultation Cases
Skill Building in Ethics Consultation...
Ethics consultation is often done but seldom taught or evaluated. It is our objective at the Neiswanger Institute for Bioethics to create materials to help persons conducting clinical consults refine their skills.
The links below provide a variety of materials to assist you in this effort. We have audio power point presentations with narration that: (1) provide an overview of what we know about ethics case consultation in the United States, and (2) give an overview of how to conduct an ethics consultation and how to evaluate your efforts. We also provide links to videos of simulated ethics case consultations. (Loyola Bioethics You Tube channel)
These consultations are not meant to be model consultations but show consultants doing their best to mediate an ethical conflict. We suggest that you use the evaluation template we have developed to rate what you think the consultants did well and what needs improvement. If you conduct consultations in your health system, you might consider using this template with your colleagues as a way to give and receive feedback.
We do not claim that you will be en expert health care ethics consultant by reviewing the materials on this site. But, many persons with little training regarding their process skills are, in fact, conducting ethics case consultation in health care institutions. We believe that the kind of materials provided can help them to refine and develop the process skills.
- About Ethics Consultations (power point)
Provides an overview of what we know about ethics case consultation in the United States.
- The Ethics Consultation Process (power point)
Gives an overview of how to conduct an ethics consultation and how to evaluate your efforts.
- Ethics Consultation Template
- Ethics Consultation Evaluation Form
Ethics Consultation Case Simulations:
CASE 1: Jacques Jones
Single ethics consultation model This case involves a patient who has had a stroke and has difficulty at this time speaking for herself in making her medical decisions. Due to swallowing difficulties, her physicians are strongly recommending placing a tube to deliver artificial nutrition and hydration (a PEG tube). The Case Outline below will tell you more about the situation. The video illustrates an individual consultant conducting the case (the other videos on this site employ a two-person team model). This video shows some very strong personalities, particularly the patient’s daughter and the neurologist, in conflict. As a result of their vocal natures, you will see that the consultant sees his role as allowing the discharge of that energy before entering the dialogue to facilitate resolution. You can assess how effective you believe this strategy to be.
Video File links:
- Part 1: Ethics Consultant Jacques Jones Meets Case Physicians (8:48 mins)
- Part 2: The Case Conference (17:40 mins)
CASE 2: Stroke Patient
This case also involves a patient who has had a significant cerebrovascular event. It shows a physician who wishes to continue life support until further evaluation can be completed in conflict with a surrogate decision maker who believes the patient would wish no further intervention. The case is especially interesting from a mediational perspective. That is, the consultants and health care professionals must honor the legitimate wishes and rights of the patient but it is important to make sure that the surrogate decision maker understands the situation and considers how the patient’s values and previous directives apply to the present situation. You might wish to consider what kind of compromises are available and legitimate in such a situation and whether the resolution reached is satisfactory. This case is also pertinent to many of our current clinical dilemmas because it challenges us to consider whether categories such as “terminal” are applicable to the patient or of what uses such distinctions might be in reaching resolution.
Video File links:
- Part 1: The ethicists meet with Dr. Murphy (16:48 mins)
- Part 2: Ms. Harper meets with the ethicists and Dr. Murphy (10:33 mins)
- Part 3: The ethics consultation concludes (16:18 mins)
CASE 3: Returning Hero
This case is an effort to process a conflict between to family members, i.e., the patient’s wife and his adult son from his first marriage. It also has two other features that are different from previous videos: (1) The attending physician is unable to be present at the meeting, and (2) a chaplain is part of the meeting. As a result, of these differences, this consultation has many different dynamics than the other videos.
Video File links:
- Part 1: The ethicists meet with Mrs. Abrams (9:08 mins)
- Part 2: Jeremy, pastoral care and Mrs. Abrams meet with the ethicists (14:56 mins)
- Part 3: The ethics consultation concludes (14:55 mins)
CASE 4: Futility Case
This case involves a patient for whom resuscitative efforts would likely bring no benefits but would impose great burdens. However, the last statements/directives of the patient included “wanting everything done.” The consultants are challenged by an attending physician whose style lacks subtlety and must try to blunt the force of her approach and try to help the surrogate decision maker to interpret the patient’s wishes in an effort to develop a consensus on a treatment plan.
Video File links: