Objectives

1. Describe the emergence of contemporary ethics consultation within clinical settings and the impact of social and regulatory forces on clinical ethics practice.

2. Describe the goals, scope, and limits of ethics consultation.

3. Discuss similarities and diferences between ethics consultation and other services whose roles may overlap with ethics consultation.

4. Explain how the resolution of clinical and organizational ethics problems is not the exclusive responsibility of any one discipline.

5. Attend to the ways group dynamics function in ethics consultation deliberations.

Case

Mr. Chan, 49, immigrated to the United States from China 25 years ago. He was recently diagnosed with T-cell lymphoma and treated with autologous stem cell transplantation. After relapse, he was treated with chemotherapy without response. He is now hospitalized with worsening liver function, abdominal distention, increasing jaundice, hepatic encephalopathy, renal dysfunction, and decreasing blood pressure. He opens his eyes, but does not follow commands.

Mr. Chan’s family consists of his wife, one daughter, and four sons. His daughter will be married in 5 days in a traditional Buddhist ceremony. The chosen wedding day is associated with special blessings for a bride and groom.

Dr. Ross, Mr. Chan’s physician, explained to Mr. Chan’s family that he is dying of end-stage disease and multi-organ failure. Dr. Ross recommended a do-not-attempt-resuscitation (DNAR) order and that he not be transferred to the ICU. Within the past day, Dr. Ross was unsuccessful in transferring another patient to the ICU because no beds were available.