Objectives

1. Outline the steps necessary for any ethics consultation to be considered adequate, fair, and complete. (mnemonic: “Gino’s Dice”)

2. Deine the three types of consulting models (individual, team, and committee) and compare their strengths and weaknesses.

3. Identify the skills and knowledge that diferent professions can bring to an ethics consult.

Case

Lisa Emory, 32, is having an uneventful first pregnancy. Lisa has discussed with her obstetrician, Dr. Stone, that she is a Jehovah’s Witness. For his part, Dr. Stone seem unfazed by the discussion, and he does not raise the issue again.

Consistent with these views, when Lisa is admitted to the hospital in labor, she tells her nurses that she would never want a transfusion, even if it would save her life. She has “the card” to prove it. When the nurse goes to document the discussion in the chart, however, she notices a note from Dr. Stone saying that he is aware that Ms. Emory is a practicing Jehovah’s Witness, but if she needs blood to save her life, he wants blood given.

In light of this note, the nurse asks for clarification from Dr. Stone, who says that his neonatal colleagues have given blood to a baby whose parents were Jehovah’s Witnesses, and he would do so for a mother because, as he puts it, “I won’t let a baby lose its mother. I’ve never lost a patient and I’m not about to start.” The nurse explains that the mother is an adult, not a child, but Dr. Stone simply thanks the nurse for her concern and walks away.

Troubled, the nurse calls her supervisor, who suggests getting an ethics committee consult.