Consensus, clinical decision making, and unsettled cases.

Area of Science:

• Bioethics
• Clinical Ethics Consultation
• Moral Philosophy

Background:

• The dominant model of clinical ethics consultation (CEC) aims to resolve conflicts and clarify value uncertainty through consensus building.
• This model assumes consensus is reached within a range of options defined by law, policy, and professional standards.
• Ethics consultants are expected to remain neutral and avoid substantive recommendations.

Observation:

• This study critiques the CEC model, arguing it's incomplete because it assumes 'allowable options' are always clear.
• A case involving a neonate with trisomy 18 (T18) illustrates this limitation, where legal, policy, and professional standards offered no clear guidance on forgoing gastrostomy tube feedings.
• Unsettled cases, where the allowability of options is unclear, pose a challenge to the standard CEC model.

Findings:

• The facilitation model of CEC is inadequate when the set of allowable options is not clearly discernible.
• In such 'unsettled cases,' ethics consultants must move beyond neutrality.
• The role of an ethics consultant should expand to include moral inquiry into defining the allowable options themselves.

Implications:

• This challenges the neutrality principle in CEC when faced with ambiguity.
• It suggests a need for a more robust framework for ethical decision-making in complex clinical scenarios.
• The findings raise questions about the extent to which ethicists should engage in evaluating the allowability of clinical options.