Ethics Consultation in U.S. Hospitals: New Findings about Consultation Practices

ABSTRACT

Background

While previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied.

Methods

To address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored.

Results

New findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants’ competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year.

Conclusions

These findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research.

Keywords:

• Ethics committee
• ethicist
• survey
• empirical research
• healthcare ethics
• clinical ethics

Acknowledgments

The authors would like to thank the following Altarum employees for their help on this work: Gillian Beach, Gregory Becker, Cydny Black, Elizabeth Blair, Erin Butto, Danisha Herrod, Jim Lee, Christine Stanik. We would also like to thank Paula Goodman-Crews and Alexander Kon for their valuable contributions to the expert panel, and Lisa Lehmann for her early involvement in the project. Finally, we would like to thank the hundreds of individuals and hospitals that participated in cognitive interviewing, pilot testing, or the survey study.

Disclosure of interest

The authors report no conflict of interest.

Disclaimer

The views expressed here are those of the authors and are not necessarily a reflection of the policies of their employers.

Notes

1 Q1, Q2, Q4, Q7, Q8A, Q8B, Q8C, Q8D, Q8E, Q8F, Q8G, Q14, Q26A, Q26B, Q26C, Q26D, Q26E, Q26F, Q34, Q34(contingent), Q35, Q41, and Q41(contingent).

2 These data were derived from the study described in Fox et al. 2021a but not previously reported.

Additional information

Funding

This work was supported by the Greenwall Foundation under a Making a Difference Grant and a President’s Award. Marion Danis’s salary was supported by the Department of Bioethics, a part of the intramural program at the National Institutes of Health.