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Is Consent Necessary for Ethics Consultation?

Abstract

Is consent necessary prior to the initiation of a specific clinical ethics consultation? This is not a question that has received much attention despite the fact that the issue of consent is one of the earliest considerations associated with bioethics. Perhaps this is because of how clinical ethics consultation, as a formidable clinical practice, came into being. Specifically, although the place and time of its conception is not readily identifiable, it is not unreasonable to say it was born on March 31, 1976, when the New Jersey Supreme Court stated, in its Quinlan decision, that consultation would be necessary with “the hospital ‘Ethics Committee’ or like body of the institution in which Karen is then hospitalized. [And i]f that consultative body agrees that there is no reasonable possibility of Karen's ever emerging from her present comatose condition [then her] life-support system may be withdrawn.”

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16. See note 15, Faden, Beauchamp 1986: Part II (ch. 3–6).

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21. See note 13, Wolf 1991:803; Fletcher 1992:292; Roberts et al. 1995:548.

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27. See note 8, Moreno, 1991:195.

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29. See footnote 28, Sulmasy 2006.

30. See footnote 28, Murphy 2005.

31. See footnote 28, McLeod, 2003.

32. See footnote 28, Malterud, Hollnagel 2005.

33. See footnote 28, Rushton 2006.

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37. See note 25, Zaner 1988:30–6.

38. Bliton MJ, Finder SG. Traversing boundaries: Clinical ethics, moral experience, and the withdrawal of life supports. Theoretical Medicine 2002;23(3):233–58.

39. See note 25, Zaner 1988:30–2.

40. This brief example is based on an actual clinical ethics consultation. Although the details have been changed in order to protect the confidentiality of all participants, the core issue regarding why ethics consultation was requested is an accurate report from the physician requester.

41. Reiter-Theil S, Mertz M, Meyer-Zehnder B. The complex roles of relatives in end-of-life decision-making: An ethical analysis. HEC Forum 2007;19(4):338–61.

42. See note 14, Bliton, Finder 1999:72–5.

43. See note 25, Zaner 1988:69–71, 105.

44. See note 9, Walker 1993.

45. See note 19, Zaner 2000:271.

46. Zaner RM. Listening or telling? Thoughts on responsibility in clinical ethics consultation. Theoretical Medicine 1996;17(3):255–77.

47. Reiter-Theil S. Balancing the perspectives: The patient's role in clinical ethics consultation. Medicine, Health Care and Philosophy 2003;6(3):247–54.

48. Fox E, Myers S, Pearlman RA. Ethics consultation in United States hospitals: A national survey. American Journal of Bioethics 2007;7(2):13–25.

49. Dudzinski DM. The practice of a clinical ethics consultant. Public Affairs Quarterly 2003;17(2):121–39.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
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