The cases in this volume exemplify a rich cross-section of consultation experiences from which we can learn. The authors tell stories and share personal responses connected to deeply affective clinical ethics cases in which they consulted. None of these authors has selected an easy case. Ambiguity, second-guessing, and regret permeate their stories and reflections. They show great courage in laying bare such things as potential missteps, institutional impotence, and interpersonal struggles. Through their openness, we have amassed a rare collection of stories from which to learn about real-life challenges encountered by clinical ethics consultants in the incredibly complex world of contemporary health care.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author describes a case involving multiple interactions between a patient’s family and the healthcare team surrounding "futile" therapy. Each new team believes that the family does not understand and tries to educate them, leading to exhaustion and lack of trust all around. The case demonstrates the complexity that arises in communication in the current healthcare system.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors describe a patient in her twenties who had a left ventricular assist device implanted in an acute circumstance to save her life before completing a heart transplant evaluation. After being delayed for being placed on the transplant list because of nonadherence to appointment, the patient asked for the device to be shut off, which would result in her death. The authors reflect on better ways to support patients in these circumstances.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors explore care for a patient with history of being abused, borderline personality disorder, substance use disorder, and a complex psychiatric history who was labeled by staff as a "hateful patient." He presents frequently after self-harming, requiring surgery and short-term psychiatric treatment. Complex behavioral issues and erratic acceptance of nursing and medical care led to staff frustration and unprofessional chart notes. Transfer to a long-term treatment setting was difficult to negotiate. Several months after discharge, the patient died. The authors are haunted by the patient’s desperation and deep loneliness. He wished he could remain hospitalized where he felt cared for. Authors wondered what more could have been done to help him.

Clinical ethics consultations can be haunting. Ethics consultants have few opportunities to reflect on the affective impact of their work. This book offers detailed cases, confessions, reflections, regrets, and triumphs experienced by ethics consultants. The authors bravely share what haunts them about the complex and demanding work of ethics consultation. Consultants experience moral distress but it’s rarely discussed. Our values are woven into the consultation. We’re not always sure if this is for better or worse. One poignant case may haunt us for our entire career. The second edition of the book includes the cases written by original authors regarding neonatology, pediatrics, palliative care, psychiatry, religious and cultural values, clinical innovation, professionalism, and organizational ethics. The book includes educational activities for ethics committees, consultants, and students at all levels of study. In the second edition, new authors reflect on clinical ethics practice, highlight how our practices have changed, and reflect on equity and diversity dimensions of patient care and ethics consultations.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors review the ethical challenges from a Canadian context when patients in acute care settings have no skilled nursing facility to which they can be discharged. They explore the policy challenges and the real impact on patient’s lives. This case highlights how individual ethics consultants can help institutions review and revise policies.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors reflect on the case of a term newborn with cardiac, respiratory, skeletal, and renal anomalies. His prognosis was unclear. Just as his respiratory status begins to improve, the baby’s parents request discontinuation of mechanical ventilation, believing he faced an inevitable, protracted death. The covering NICU team requests an ethics consultation. The consultant supports the parent’s decision and the baby died in his parent’s arms. When the NICU team returns, they express great concern, believing that terminal withdrawal at this point should have been discouraged, leaving the authors haunted by the consultation.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author explores the complexities of maternal–fetal surgery when it was in its infancy. When spina bifida was detected at 18 weeks gestational age, the patient and her partner chose not to terminate the pregnancy. The ethics consultant explored emotional, ethical, medical, and social issues that impact her decision, including the risk of losing the pregnancy because of the surgical intervention. She lost the baby and the ethics consultant is struck by the patient’s tenderness in the midst of great loss. He digs deeply into the fragility of being human and the preciousness of sharing these experiences with patients and their families.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author discusses a dying patient’s adult children in disagreement about a care plan. The issue of when home herbal remedies can be provided for a patient was central to the discussion. In addition, the ethics consultant had family members see a counselor to attempt to resolve their dispute, which is not a common approach.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author describes a 31-year-old living unrelated donor candidate who wants to direct her kidney donation to a church acquaintance. Her motivation was, first and foremost, based on her religious commitments to altruism but also mentioned the possibility of a romantic relationship with the recipient, without any expectation that this occur in exchange for her donation. The recipient’s mother would be her caregiver after surgery. The ethics consultant recommended delaying transplant to further explore her motivation and the possibility of coercion (a desire to please her religious community, for example). The author, also a Christian clergyman, is haunted by the notion that donation is "the will of God" and the potential influence of the donor’s loneliness.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors describe the case of a 55-year-old patient with severe cachexia and malnutrition with a long history of anorexia. Her family helps with ADLs. She was admitted of her own accord for abdominal pain. She declines psychiatric evaluation. She lacked decisional capacity for treatments related to disordered eating like nasogastric feeding. Her husband was always persuaded by his wife at the last minute. The authors are haunted by the question of whether she had an underlying psychiatric issue that was unaddressed, that her husband was not acting in her best interest, and there was insufficient assistance from the psychiatry service.

This chapter in Complex Ethics Consultations: Cases that Haunt Us, the authors describe a 9-year-old girl newly diagnosed with T-cell acute lymphoblastic leukemia. She experienced virtually every side effect, reducing the normally high cure rate to 20%–50%. When remission was short, she would need high-dose chemotherapy. The child repeatedly said she would rather die than go through more treatment. Her parents were aligned with her wishes. The attending physician thought withdrawal was paramount to child abuse and soon the decision was left to the court. Parents decided to permit low-dose chemotherapy. The family’s lawyer developed warm relationships with the family, while the ethicist was the “enemy,” representing the hospital. They feared for the patient, who died months later.

It is commonly believed that our obligations toward other human beings are not restricted to abstaining from harming them. We should also prevent or alleviate harmful states of affairs for other individuals whenever it is in our power to do something about it. In animal ethics, however, the idea that we may have reasons not only to refrain from harming animals but also to help them is not particularly widespread. Of course, exceptions can be found regarding companion animals. Most people agree that failing to assist them would be wrong if we could otherwise help them. Most people give their companion animals veterinary care and believe such care should be extended to all captive animals. But what about all other animals in need, shouldn’t we also help them? Consider The Drowning Chimp case introduced at the beginning of this book. Do you have an obligation to save the chimp? Consider also the numerous rescues of animals trapped in the ice or the recent efforts of Australian authorities and communities to help kangaroos, camels, horses, koalas, alpacas, and many other animals caught in the flames to survive as well as the aerial distribution of food in the days following the fires. Isn’t that something that we ought to do?