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5 - Mission, vision, goals: defining the parameters of ethics consultation

Published online by Cambridge University Press:  05 August 2012

D. Micah Hester
Affiliation:
Division of Medical Humanities, University of Arkansas
Toby Schonfeld
Affiliation:
Emory University, Atlanta
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Summary

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.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2012

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References

American Society for Bioethics and Humanities 2009
American Society for Bioethics and Humanities 2011
Andre, J 1997 Goals of ethics consultation: toward clarity, utility, and fidelityThe Journal of Clinical Ethics 8 193Google ScholarPubMed
Bean, S 2011 Navigating the murky intersection between clinical and organizational ethics: a hybrid case taxonomyBioethics 25 320CrossRefGoogle ScholarPubMed
Beauchamp, TLChildress, JF 2009 Principles of Biomedical EthicsNew YorkOxford University Press136Google Scholar
Committee on Bioethics 1995 Informed consent, parental permission, and assent in pediatric practicePediatrics 95 314Google Scholar
Glaser, JW 1989 Hospital ethics committee: one of many centers of responsibilityTheoretical Medicine and Bioethics 10 275CrossRefGoogle ScholarPubMed
Nelson, WAWeeks, WBCampfield, JMMacLeod, L 2008 The organizational costs of ethical conflictsJ Hlthcare Managem 53 41Google ScholarPubMed
Smith, MLBisanz, AKKemper, A 2004 Criteria for determining the appropriate method for an ethics consultationHEC Forum 16 95CrossRefGoogle ScholarPubMed

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