Defining and Refining Trauma-Informed Ethics Consultation

AbstractThis article responds to Autumn Fiester's "TIEC, Trauma Capacity, and the Moral Priority of Surrogate Decision Makers in Futility Disputes," in which Fiester argues for a vision of trauma-informed ethics consultation that systematically prioritizes the preferences of surrogate decision makers in cases of disagreement between surrogates and clinical teams over continued life-sustaining therapies for severely neurologically impaired patients. We identify three issues arising from Fiester's article that allow us to clarify our account of trauma-informed ethics consultation on which she builds and that illustrate the need for further research on trauma-informed ethics consultation in both theory and practice. The first issue responds to her charge that ours was an overly "modest" proposal. The second issue is to suggest closer attention to distinctions between ethics consultation process, methods, and content that we argue would enhance Fiester's account. The third is to better evaluate the appropriate role of "ethically acceptable options" in trauma-informed ethics consultation. In conclusion, we raise several global points regarding the further development of trauma-informed ethics consultation and conceptualizations of trauma-informed care relevant to it.