Experience of Individual Clinical Ethics Consultations in a Regional Hospital

Individual clinical ethics consultation (CEc) is a tool for resolving clinical ethical conflicts and/or dilemmas at the patient's bedside. It originated in the United States and has spread to other countries. This publication presents the experience of the CEc service in the Bioethics and Humanization Unit in the Arica Regional Hospital. It is the first formally established service for this purpose in the Chilean public health network.

To characterize the CEcs carried out in terms of frequency, response time, requesting units or services, and types of bioethical conflicts and/or dilemmas faced, under the individual consultant modality, 2022 - 2024.

The total number of CEcs carried out between January 2022 and December 2024 was obtained from the records of the individual clinical ethics consultant, a clinical physician with a master's degree in bioethics, who used the Jonsen four-box method to analyze the cases in his routine consulting work. An anonymized database of sensitive data was used to collect the information and meet the objectives.

Of the 460 CEcs carried out, almost all were requested by physicians. The individual CEc model was characterized by its rapid response, the time dedicated to each case, and the follow-up of the recommendations provided to the requesters. Critical care units accounted for the largest number of CEcs, with issues of proportionality and adequacy of therapeutic effort being the most frequently identified conflicts and/or dilemmas.

The CEc service, based on the individual consultant model, has proven effective in resolving ethical-clinical conflicts and dilemmas, promoting bioethical education for healthcare professionals and acting as a facilitator between patients, clinical teams, and families, fulfilling a humanizing role in daily clinical practice.