URMC / Clinical Ethics / SMH Consult Service
Choices about patient care always involve values, and a discussion of the patient's and doctor's values may help both to make their decisions. The Ethics Consultation Service helps patients, families, and caregivers to explore the issues and choices surrounding difficult decisions.
Situations where an ethics consultation might be helpful include, but are not limited to:
When there are questions about decision-making authority. For example, the patient seems to lack capacity to make medical decisions for him or herself, but it is not clear who has the authority to make decisions in his or her place.
When there are questions about treatment goals. Often these involve treatment goals at the end of life, such as decisions to forgo or withdraw life-sustaining interventions, DNR orders, etc.
When family members disagree about the treatment goals of the incapacitated patient. These situations often involve issues of decision-making authority and treatment goals.
A consultation is typically arranged by the attending physician or another member of the healthcare team, although patients, family members, or others may contact the Service directly. A formal consultation involves meeting with the patient and family and/or friends, and discussions with the attending physician and other members of the healthcare team. The Ethics Consultation team writes a consult note which assesses the particular ethical issues and makes recommendations for resolution; this note is included in the patient's chart.
This service is financed by the hospital at no cost to the patient.
Medical students who choose to do an elective in Clinical Ethics will have an opportunity to work on this Service and participate in all its activities.
Why Request an Ethics Consult?
Ethics consults aid decision making in complex situations; they are most often not a sign of "failure" or moral lapses.
Most cases involve one of the following:
Unclear treatment goals
- How to decide among several reasonable treatments?
- Is the treatment offered against the patient values?
- Is treatment requested not usual medical practice?
- Is there a difference of opinion which treatment is most desirable for this patient at this time?
Uncertainty regarding decision-making roles
- Who is the rightful decision maker?
- How should the person make the decision?
- Does the patient have the capacity to make this decision?
- What if there is disagreement about the best decision?
Assistance in conflict resolution
- Between providers and family/patient
- Within a family
- Within or between treatment teams
- Within a person (who is ambivalent or in denial)
Who May Call for an Ethics Consult?
Any member of the healthcare team, patient, or family can request an ethics consultation.
Attending physicians, residents and fellows, nurses, technicians, therapists, social workers, and others involved in a patient’s care may request an ethics consultation.
The requestor’s name can be kept confidential, but the medical attending of record will be notified that an ethics consultation has been called about his patient.
How to Contact Us
Clinical ethics consults are available 24 hours a day, 7 days a week. Call the Strong Memorial Hospital Operator/Paging Service at (585) 275-2222 and ask them to page the Clinical Ethics Consultant on call. Urgent consults are possible.
Who We Are
Ethics consultants include:
- Rachel Diamond, MD, MS, Ethics Fellow
- David Kaufman, MD
- Michael Nabozny, MD, Ethics Fellow
- Marjorie Hodges Shaw, JD, PhD, HEC-C
- Nicholas R. Mercado, Dr. PH, MPH
What We Do
When an ethics consult is requested, we notify the patient’s attending physician that a consult has been requested, if he/she did not request the consult themselves. As the person responsible for the patient’s medical care, the attending needs to be informed of the questions raised, and to sum up the medical course, as well as review possible therapeutic options offered to the patient.
Depending on the nature of the consultation (question asked), one or more ethics consultant may interview the patient, housestaff and other trainees, nurses, social workers, other consultants, chaplains, hospital counsel (legal office), or other interested persons. Not all cases need interviews from all of the above. If indicated, we request a patient’s permission to discuss their care with their family members.
In some instances, interviews with those involved leads to a clarification of options. In other instances, we may facilitate a team meeting or family conference to assist in selection of a plan of action or resolution.
When necessary, we may draw on expertise from other members of the ethics committee to assist in these activities.
The ethics consultation note is placed in the patient’s record, if appropriate.