Ethics Consultation in U.S. Hospitals: Adherence to National Practice Standards

Abstract

Background

Adherence to widely accepted practice standards is a frequently used measure of healthcare quality. In the U.S., the most widely recognized authoritative source of practice standards for ethics consultation (EC) is the second edition of the American Society for Bioethics and Humanities’ Core Competencies for Healthcare Ethics Consultation report.

Methods

To determine the extent to which EC practices in U.S. hospitals adhere to these practice standards, we developed and analyzed 12 evaluative measures from a national survey.

Results

Only three of the 12 standards achieved over 75% adherence with reported EC practices: allowing anyone involved in a case to request an EC (100%), not requiring an attending physician’s permission to conduct an EC (97.6%), and having at least one person on the ethics consultation service (ECS) with advanced level EC proficiency (79.3%).

Conclusions

Implications are discussed for achieving consensus on EC standards as they continue to evolve.

Keywords:

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

Acknowledgment

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.

Disclaimer

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

Disclosure statement

No potential conflict of interest was reported by the authors.

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.