To our knowledge, no existing book or article describes how to establish and operate a vibrant and sustainable clinical ethics consultation service (ECS) from the ground up. As a result, ECS directors and ethics consultants may be charged with building or reinvigorating and sustaining a high-quality, successful service without sufficient practical guidance on how to plan, implement, and monitor their efforts. This lack of guidance can give rise to problems, including wasted time and effort, as well as misalignments in expectations and goals between hospital administrators and ethics consultants on what constitutes "success" and "failure" in service activities. Toward the goal of providing this much-needed guidance, we describe key considerations and strategies for developing, implementing, and monitoring a high-quality, successful service. It is important to note that in responding to hospital administrators' expectations and establishing a successful service, it is necessary but not sufficient to demonstrate the competence of individual consultants. Thus, some portions of this guide are addressed to the individual or individuals leading an ECS, but many chapters will be useful to anyone engaging in clinical ethics consultation or playing a role in overseeing or otherwise advocating for an ECS. Our focus is on building and sustaining high-quality, successful services in ways that go well beyond the traditional focus on how to conduct an ethics consultation. Specifically, we have chapters and sections devoted to working through a case, mediation skills, and conducting and facilitating family meetings that should be useful for any ethics consultant, particularly individuals who are new to ethics consultation or seasoned consultants who wish to reflect on their practices, but we also have chapters and sections devoted to "selling points to hospital administrators on the value of ECSs," building an ECS infrastructure, launching a service, etc., that are aimed more towards ECS directors, with the goal of providing essential guidance on ECS development and maintenance. Finally, our goal is to be as practical and clinically-oriented as possible by addressing everyday nuts-and-bolts concerns that apply across demographically- and geographically-diverse hospital settings, subject to some individual variation that we will underscore for our readership. In particular, we arrange this guide according to phases of an ECS. Part 1 will focus on planning for an ECS. Part 2 will discuss how to implement an ECS. Part 3 will then conclude with information about how to monitor an ECS once it is established, and how to address common challenges. We believe that much of the advice we provide can be extended to other consultative or hospital services that are based in hospitals, such as palliative medicine, chaplaincy, or social work services. We hope you find this useful!
The Center for Medical Ethics and Health Policy at Baylor College of Medicine (BCM) is one of the leading academic centers in the field of biomedical ethics and health policy. The Center was founded in 1982 as a joint program between BCM and Rice University. The impetus for founding the Center was the recognition that the ever-increasing abilities of medicine raise fundamental value questions of how society should use these abilities and how much of them society can afford to use. The very success of medicine has made its practice morally complex as well as challenging for healthcare policy. The Center's mission is to conduct cutting-edge multidisciplinary research on emerging, as well as perennial, ethical issues arising in clinical practice and in biomedical research in a changing environment. In creating this guide, we drew on the collective wisdom of colleagues who have built successful services, informed by expert opinion and literature reviews. The Center for Medical Ethics and Health Policy has 30 years of experience conducting ethics consultations in adult and pediatric tertiary, academic, and community hospitals. Center faculty organize and teach an annual Intensive Bioethics Course in partnership with Houston Methodist, with a particular emphasis on training the next generation of ethics consultants. We regularly contribute to the academic literature on clinical ethics consultation, and some of our faculty hold leadership positions in professional societies, including the American Society for Bioethics and Humanities (ASBH) and the Clinical Ethics Consultation Affairs (CECA) Standing Committee, owing to our experience and reputation for excellence in developing and leading ECSs and conducting high-quality ethics consultations. Some of our clinical ethicists have conducted over 2,000 clinical ethics consultations. Moreover, because developing and running an ECS requires expertise in program administration as well as ethics consultation, and that an ECS is typically part of a larger clinical ethics or bioethics program that includes educational and policy work, our group has expertise and experience that extend beyond ethics consultation.
