Frequently Asked Questions

Years of experience working in the field with all varieties and sizes of hospitals and hospital systems (including teaching hospitals, faith-based institutions, not-for-profit and for-profit), all across America.

Here are just a few quotes that may be helpful in understanding the impact of hospital ethics committees and healthcare ethics consultation services:

• “Among the most effective and valued resources in health care decision making is … the institutional ethics committee. As medicine becomes more complex, fiscal and bureaucratic pressures mount, and governmental regulations expand, clinicians and administrators increasing look to [the institutional ethics committee] for analysis and guidance in resolving health care problems. Depending on the size and the needs of the institution, the ethics committee typically serves as a moral analyst, information clearing house, dispute mediator, educator, policy reviewer, and clinical consultant. The importance and scope of these responsibilities suggest that committees should be familiar and confortable with bioethical theory and analysis, clinical consultation skills, institutional policies, legal precedents, organizational function, and resource allocation.”
  – From Post LF, Blustein J, Dubler NN. Handbook for Health Care Ethics Committees. Baltimore, Maryland: The Johns Hopkins University Press, 2007, p. xi.

• “The effectiveness of an ethics committee depends in large part on whether it is marginalized or fully integrated into the functioning of the institution.”
  – From Post LF, Blustein J, Dubler NN. Handbook for Health Care Ethics Committees. Baltimore, Maryland: The Johns Hopkins University Press, 2007, p. xiii.

• “[Many] know only too well that the cases brought for clinical ethics consultation are often complex and emotionally charged. Consultations are often requested as a last resort when members of a health care team, patients or family members are in conflict, and their differences seem almost beyond resolution. From informed consent, decision-making capacity, and confidentially to end of life decisions, the ethical issues raised come inextricably bound up with, among other things, medical, legal and psychological issues. To be able to address these complex, multifaceted ethical issues under the time pressures of the clinical setting requires more than good intentions and enthusiasm; it requires particular knowledge and skills (Aulisio, 1999).”
  – From American Society for Bioethics and Humanities Clinical Ethics Task Force. Improving Competences in Clinical Ethics Consultation: An Education Guide. Glenview, Illinois: American Society for Bioethics and Humanities, 2009, p. 1.

• “In the years since Core Competencies [for Healthcare Ethics Consultation] was published [by the American Society for Bioethics and Humanities in 1998], new data on clinical ethics consultation in the United States have come to light. More than 81% of all hospitals now have an ethics consultation service of some kind (in contrast to less than 1% of hospitals identified in a 1981 study. … Today, an estimated 35,000 individuals are involved in performing more than 15,000 ethics consultations each year in U.S. hospitals [citing the 2007 article by Fox, Meyers, and Pearlman].”
  – From American Society for Bioethics and Humanities Clinical Ethics Task Force. Improving Competences in Clinical Ethics Consultation: An Education Guide. Glenview, Illinois: American Society for Bioethics and Humanities, 2009, p. 1.

• “Individuals performing clinical ethics consultation come from a variety of personal and professional backgrounds, with physicians (36%), nurses (30%), social workers (11%), chaplains (10%), and administrators (10%) making up the vast majority of those who perform ethics consultations in the United States. In 68% of U.S. hospitals, ethics consultation is generally performed by small teams, rather than full committees (23%) or individual consultants (9%). … Only 5% of people performing ethics consultation in the United States have completed a fellowship or graduate program in bioethics, and only 41% learned to perform ethics consultation with formal, direct supervision by an experienced member of an ethics consultation service [citing the 2007 article by Fox, Meyers, and Pearlman].”
  – From American Society for Bioethics and Humanities Clinical Ethics Task Force. Improving Competences in Clinical Ethics Consultation: An Education Guide. Glenview, Illinois: American Society for Bioethics and Humanities, 2009, p. 1.

Most ECG healthcare ethics consultants are faculty at accredited educational institutions who train clinical ethics consultants and mediators. Several well-established programs around the country train clinical ethicists. For Example, Alden March Bioethics Institute (AMBI) at Albany Medical College, Albany, New York, offers several options to help individuals acquire the core educational and core skills competencies critical for those offering clinical ethics consultation services. AMBI offerings include a one-year onsite clinical ethics fellowship, an online graduate certificate in clinical ethics, and an online master of science in bioethics.  More information about AMBI educational programs may be found at: https://www.amc.edu/academic/bioethics/educational_programs/index.cfm. ECG works with institutional ethics committee champions and leaders and recommends that these individuals acquire as much formal education and training in healthcare ethics and conflict resolution as practical.

At the present time, each hospital sets its own standards for clinical privileges to provide clinical ethics consultation services. Some hospitals permit clinicians to offer clincal ethics consultation services as individuals, other hospitals provide these services through small teams of professionals, and some hospitals convene the entire ethics committee to deal with consultation requests. The American Society for Bioethics and Humanities (ASBH) – the largest organization of bioethicists in the US – first published its core educational and skills competencies, which describes peer-established minimums for healthcare ethics consultation services, in 1998. More information about these ASBH core competencies may be found at: http://www.asbh.org/publications/content/core.html. ECG also recommends that those interested in learning healthcare ethics consultation core educational and skills competencies strongly consider the programs that emphasize the ASBH competencies in the educational process. ECG supports peer standards in healthcare ethics consultation services and peer accreditation of programs that purport to train individual healthcare ethics consultants.

Each hospital is unique. There is no established pattern, nor set number for ethics consultation requests per hospital. However, one may make fairly accurate estimates based on available data. There have been national and statewide surveys in the recent past, which help ethics committees, and ethics consultation services predict volume and character. Dr. Ellen E. Fox and her colleagues the Department of Veterans Affairs Integrated Ethics program in 2007 published one of the largest and most extensive surveys. This article may be found at: Fox E, Myers S, Pearlman RA. Ethics consultation in United States hospitals: a national survey. Am J Bioeth. 2007 Feb: 7(2): 13-25. Several ECG healthcare ethics consultants have been involved in collecting and publishing this type of information regionally as well. One such publication is available at: http://vitalysthealth.org/wp-content/uploads/2014/02/ib-08summer.pdf

Our clients are institutions, primarily hospitals and health systems. After conversation about engagement goals, needs, and timelines, Ethics Consultant Group, LLC (ECG) submits a proposal and draft agreement to the potential client.

Typically, less than 5 hours each month. ECG healthcare ethics consultants will exchange emails or talk by phone with the ethics committee contact and help plan a monthly or quarterly activities calendar, or “attend” ethics committee or ethics consultation services team meetings by conference call, or provide an educational program, or be available for a particular thorny ethics consultation conference, or coach ethics consultation team members in an approach to deal with an immediate concern.

Having conversations with ethics committee champions and leaders to plan for meetings and answer questions about goals and process; assisting ethics committee consultation service members with particularly difficult cases; offering specific educational programs for staff and ethics committee members via distance-learning and video webinar systems; reviewing organizational policies and procedures; drafting written educational materials for training purposes; “attending” meetings and serving as available resource during sessions.

Because services are individualized to client goals and needs, charges and fees are individualized too. Typically ECG engagements involve retainer agreements for a term of 12 months.

Yes. Some clients request that ECG begin the engagement by visiting the institution’s campus or campuses. We have found initial face-to-faced encounters very helpful in establishing rapport and trust. Clients often take advantage of sites visits by scheduling as many meetings and events as time permits, such as conferences with senior administrators and ethics committee champions and leaders, a meeting of the ethics committee or ethics consultation team members, and often educational programs for physicians, nurses, and other staff. Occasionally, clients will ask ECG consultants to visit to complete an on site needs assessment to make recommendations to senior management about re-energizing the ethics committee or help develop a plan to take the ethics committee to the next level of service and effectiveness. Sometimes ECG consultants visit to help deal with very specific issues related to conflict resolution. And, sometimes ECG consultants visit to help develop research initiatives to help demonstrate effectiveness or validate quality assurance or outcomes strategies. However, most often, ECG ethics consultants are invited to speak on healthcare ethics topics at continuing education program organized to help staff.

Together the tools of clinical ethics and consensus building provide health care professionals with needed skills in addressing difficult relationships, designing systems to improve relationships, and training providers of clinical services to maximize medical outcomes and minimize disruption to the effective delivery of health care.

When we use the word mediation, we do not mean mediation as commonly thought of in court cases or litigation.  Mediation can be defined as impartial assistance provided to individuals engaged in difficult conversations. Mediators are trained facilitators who assist in conducting negotiations between people who are seeking to reach agreement.  Many ethics consultations are of this nature.  Families may need assistance making decisions about the nature of medical care for an incapacitated loved one.  Medical providers may need assistance in determining the best course of treatment.  Health care institutions may need assistance in resolving recurrent problems in providing optimal care when objectives are unclear or interests seem to be in opposition.  Professionals trained in the skills of negotiation, facilitation and mediation, such as many of the ECG healthcare ethics consultants, can assist in assessment, system design and training in settings which can benefit from managing the inevitable conflicts that sometimes arise in health care. One of the strongest proponents for using mediation skills in clinical ethics consultation services is nationally known bioethicist Nancy N. Dubler. See Dubler NN, Liebman CB. Bioethics Mediation: A Guide to Shaping Shared Solutions. New York, New York: United Hospital Fund of New York, 2004.