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Ethics Consultation in Surgical Specialties.

Nicole A Meredyth1, Joseph J Fins2, Inmaculada de Melo-Martin3

  • 1Department of Medicine, Division of Medical Ethics, Department of Surgery, Weill-Cornell Medicine, 435 East 70thSt, 4J, New York, NY, 10021, USA. Nam9121@nyp.org.

HEC Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
|March 6, 2021
PubMed
Summary

This study found that surgical specialties frequently request ethics consultations for end-of-life care decisions, while non-surgical specialties often seek guidance on discharge planning. These findings highlight specialty-specific ethical challenges in healthcare.

Keywords:
Ethics consultationSurgical buy-inSurgical ethicsWithholding/withdrawing life-sustaining treatment

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Area of Science:

  • Medical Ethics
  • Health Services Research
  • Clinical Ethics

Background:

  • Ethics consultation services address common ethical dilemmas, but data comparing specialty-specific requests is limited.
  • Understanding differences in ethics consultation content across hospital specialties is crucial for targeted support.
  • It remains unclear if the scope of ethical dilemmas varies between surgical and non-surgical specialties.

Purpose of the Study:

  • To retrospectively assess the incidence and content of ethics consultations requested by surgical versus non-surgical specialties.
  • To identify differences in the types of ethical dilemmas prompting consultations based on specialty.
  • To determine if consultation frequency varies by specialty.

Main Methods:

  • Retrospective analysis of 548 ethics consultations from January 1, 2013, to December 31, 2018.
  • Data sourced from a RedCap Database and electronic medical records (EMR) via a Clinical and Translational Science Center.
  • Comparison of consultations initiated by surgical (n=135) and non-surgical (n=413) specialties.

Main Results:

  • Surgical consults more frequently originated from the Intensive Care Unit (ICU) compared to lower acuity units (45.9% vs. 14.3%).
  • Surgical patients were more likely to have a Do Not Resuscitate (DNR) order (37.5% vs. 22.2%).
  • Surgical specialties focused on withholding/withdrawing life-sustaining treatment, while non-surgical specialties addressed discharge planning.

Conclusions:

  • Significant differences exist in the ethical issues prompting consultations between surgical and non-surgical specialties.
  • Current ethics consultation classification systems may not fully capture morally relevant distinctions.
  • Findings can inform ethics consultation services to better educate specialties on their unique ethical challenges.