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Ethical Dilemmas II

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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

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Assessing clinical ethics consultation: processes and outcomes.

¹The Bioethics Institute, Loyola Marymount University, USA.

Medicine and Law

|August 24, 2013

Summary

Clinical ethics consultation (CEC) is vital for resolving patient care dilemmas. Current outcome evaluations are flawed; focusing on process indicators is key to assessing CEC quality and improving healthcare ethics.

Area of Science:

Medical Ethics
Healthcare Management
Clinical Quality Improvement

Background:

Clinical ethics consultation (CEC) is a widely adopted hospital service for addressing complex patient care ethical issues.
There is a recognized need to evaluate the effectiveness and quality of CEC services.
Existing evaluations of CEC have primarily focused on outcome indicators.

Purpose of the Study:

To review formally evaluated outcomes of clinical ethics consultation.
To critically assess the suitability of outcome indicators for evaluating CEC.
To propose alternative approaches for assessing the quality of CEC.

Main Methods:

Literature review of studies evaluating outcomes of clinical ethics consultation.
Analysis of the limitations of using healthcare cost, ICU clinical indicators, and user satisfaction as sole evaluation metrics.

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Conceptual exploration of process indicators as a more direct measure of CEC quality.

Main Results:

Evaluated outcomes (healthcare cost, ICU indicators, user satisfaction) are contingent and not directly controlled by CEC, limiting their utility for assessing CEC's worth.
The inherent necessity of resolving ethical dilemmas provides a fundamental justification for CEC, independent of outcome measures.
Outcome indicators can serve as heuristics but do not directly capture the quality of the consultation process.

Conclusions:

Outcome-based assessments are insufficient for evaluating the true value of clinical ethics consultation.
Process indicators offer a more direct and reliable method for assessing CEC quality.
Future research should focus on developing conceptual models and assessment methods for CEC processes.