Who Receives Ethics Consultations? An Analysis of Racial and Ethnic Characteristics of an Ethics Consult Service in...

In healthcare settings, it is crucial to understand the identities of patients receiving services, both for cultural considerations and to identify and prevent disparities in care.

Our retrospective observational study analyzed 763 adult bioethics consultations from 2016-2024 at a large urban academic health system and compared the demographics of patients receiving bioethics consultation to the general patient population. We also evaluated demographic differences between patients receiving consults for different categories of ethics issues.

We found that Hispanic and Asian patients were underrepresented among those receiving ethics consults, while Black and White patients were overrepresented. Additionally, patients receiving consults were more likely to be male and older. Consults for refusal of medically indicated care were significantly associated with younger age, HIV/AIDS diagnosis, and having diabetes with complications. Initial bivariable associations of consults for refusal of medically indicated care with race and language did not remain significant after adjustment for confounders.

The finding that Hispanic and Asian patients were less likely to receive ethics consults may reflect language-related communication barriers or underrecognition of ethics-related concerns. Findings highlight racial and linguistic disparities in ethics service utilization, which may mirror broader structural inequities in care delivery and provider communication. Addressing these gaps is essential for advancing ethical, culturally responsive care. Future efforts should focus on improving access to ethics resources for marginalized groups and investigating how structural racism and communication dynamics influence ethics consult initiation.