Current models for clinical ethics consultation reimbursement

The author reviewed the literature on compensation for ethics consultation and undertook an informal telephone survey of 33 nationally prominent clinical ethics consultants in American health care institutions and medical schools in late fall 1992. Twenty-nine (88%) of 33 consultants responded. Most donate their time when asked to consult and are not paid directly for consultation services. Other ethics consultants, however, provide services to colleagues and patients and are compensated by private practice billing, salaried arrangements, and income from ethics training programs. Salaried arrangements through managed-care organizations seem to hold the greatest promise for ethics consultants who wish to be paid, although such arrangements raise ethical issues themselves. To be paid at all, ethics consultants called on by family physicians to see patients may be asked to balance institutional cost-effectiveness with the personal bedside process of ethics consultation.