Trauma Informed Ethics Consultation

Abstract

We argue for the addition of trauma informed awareness, training, and skill in clinical ethics consultation by proposing a novel framework for Trauma Informed Ethics Consultation (TIEC). This approach expands on the American Society for Bioethics and Humanities (ASBH) framework for, and key insights from feminist approaches to, ethics consultation, and the literature on trauma informed care (TIC). TIEC keeps ethics consultation in line with the provision of TIC in other clinical settings. Most crucially, TIEC (like TIC) is systematically sensitive to culture, history, difference, power, social exclusion, oppression, and marginalization. By engaging a neonatal intensive care ethics consult example, we define our TIEC approach and illustrate its application. Through TIEC we argue it is the role of ethics consultants to not only hold open moral spaces, but to furnish them in morally habitable ways for all stakeholders involved in the ethics consultation process, including patients, surrogates, and practitioners.

Keywords:

• Children and families
• ethics committees
• feminist ethics
• mental health
• professional-patient relationship
• race and culture/ethnicity

This article is referred to by:

Trauma and Community: Trauma-Informed Ethics Consultation Grounded in Community-Engaged Principles

What Happened to Dad? The Complexity of Paternal Trauma and Ethical Care

Extending Trauma-Informed Principles to Hospital System Policy Development

When Obligations Conflict: Necessary Violations of Trauma Informed Care in Ethics Consultation?

Trauma-Informed Approaches in Healthcare Ethics Consultation: A Missing Element in Healthcare for People Who Use Drugs during the Overdose Crisis?

My Story is Traumatic, You Probably Would Not Understand

Trauma-Informed Ethics and Relational Health

ACKNOWLEDGEMENTS

We are grateful for the opportunity to present an early version of this paper at the 21st annual American Society for Bioethics and Humanities meeting in 2019 and the feedback we received from participants and attendees in the “Clinical Ethics in the NICU” session. In developing this work, we benefitted from discussions with Kelly W. Harris, Carey DeMichelis, Kate Payne, and Joseph B. Fanning. We are especially appreciative of Larry Churchill’s notes on an early draft of this paper and two anonymous reviewers for detailed recommendations on later drafts.

Notes

1 Genomic imprinting is the modification of gene expression due to environmental changes in which of the pair of alleles from both parents, one is silenced resulting in expression of only a singular allele. “Weathering” is the deterioration of health in early adulthood as a result of aggregate exposure to toxic stress such as racism, discrimination, and economic disadvantages.