Clinical Ethics Consult Myth Busting

Myth: Clinical ethics consultations provide legal advice

Fact:

A request for an ethics consultation to analyze a clinical ethical issue in a case, outline ethical options, or make recommendations often does elicit legal information, though not automatically (Spielman, 1993). The role of the ethics consultation is to explore the biopsychosocial issues that are relevant to the case to provide support and guidance stakeholders. The often requires the ethics consultant to become familiar with the relevant local, state, and possibly federal laws that have ethical implications for a patient, however ethics consultants do but not provide legal advice. 

An example for when an ethics consultant would relay legal knowledge would be when there are questions about an ethically appropriate surrogate decision-maker for a patient who lacks decision-making capacity. Familiarization with New York States legal surrogate decision-making hierarchy and standards outlined in the Family Health Care Decisions Act of 2010 is necessary to make an ethical argument about the appropriateness of a potential surrogate decision-maker (Swidler & Rivera, 2021). Surrogate decision-making is one of the most common clinical ethical issues in healthcare; and one of the few ethical issues specifically addressed by a law.   

Ethics consultants will not provide recommendations that are in direct violation of the law or institutional policy. Consultants will confer with legal counsel when necessary.

Reference

Spielman, B. (1993). Invoking the law in ethics consultation. Cambridge Quarterly of Healthcare Ethics, 2(4), 457-467. 

Swidler, R. N. & Rivera, J. L. (2021). Family Healthcare Decisions Act summary of key provisions. NYSBA Health Law J, 26(2). 

Contributed by: Dr. Nicholas Mercado, May 2025

Myth: Clinical ethics consultants make complex decisions about clinical cases

Fact:

Like other consultative services in the hospital, the clinical ethics consultation service provides recommendations. These recommendations are based on several factors:

1. Medical Indications – clinical ethics consultants review the patient’s medical record and speak with physicians, nursing staff, and other members of the interprofessional team to understand the patient’s medical condition.
2. Patient Preferences – clinical ethics consultants speak to the involved stakeholders and review relevant documentation to understand the patient’s preferences for treatment. 
3. Quality of Life – clinical ethics consultants evaluate the discussions and documentation to understand how patient defines their quality of life. 
4. Contextual Features – clinical ethics consultants acknowledge the biopsychosocial factors that have implications for patient care but might be non-modifiable at present. 

Ethics consultation recommendations are formalized and documented in the patient’s medical record. The clinical ethics consultant will follow-up with the patient, family, and healthcare team on these recommendations as needed. 

Reference

Jonsen, A. R., Siegler, M., & Winslade, W. J. (2022). Clinical ethics: A practical approach to ethical decisions in clinical medicine. (9^th ed.) McGraw Hill.

Contributed by: Dr. Nicholas Mercado, January 2025

Myth: Clinical ethicists are the "ethics police." Some believe that our role is tied to the hospital’s legal, compliance, or Human Resources departments, tasked with monitoring or reporting unethical behavior.

Fact: 

The purpose of the clinical ethics consult service is to help clinicians and hospitals provide care that is medically appropriate and reflects patients’ values and preferences. The most common ethics consult at SMH occurs when various members of the team, including patients and family, express different values influencing medical decision-making. As appropriate, ethics consultants meet with team members, the patient, surrogate decision-makers, and family members to help understand the nature of the disagreement and make recommendations that respect both ethical principles and legal or institutional obligations. Ethics consultants work collaboratively with legal counsel and institutional leadership to ensure the highest ethical standards in clinical practice. Taking care of patients can involve morally complex decisions. We are one part of the multidisciplinary team and function in a supportive role—rather than as oversight..

Contributed by: Dr. Bryanna Moore & Dr. Margie Hodges-Shaw