Clinical ethicists bridge doctor-family communication gap

In the healthcare business, situations inevitably arise where clinicians disagree with one another or clinicians and patients' families disagree on the best course of action, which is where clinical ethics consultations come in, according to Medscape.

Ethics consultations are distinct from hospital ethics committees, Nancy Dubler of New York University Medical School told Medscape. While a committee addresses institutional policies on issues such as brain death or do-not-resuscitate orders, consultations involve individual, ongoing cases. Ethics committees sometimes participate in consultations, Dubler said, but she advised against this practice, as that can potentially intimidate patients.

The first step of an ethics consultation is to meet with the staff, Dubler said, because any lingering friction will seep into the actual consultation process. "You have to read the chart. You have to be educated about what the case is," she told Medscape. "But you are neutral, and you bring this neutrality into a difficult situation."

The next step is to meet with a subsection of the staff, the patient and his or her family. It's important to include staff in this process, Dubler said, because excluding them can create a sense of "us vs. them." Dubler calls the process "STADA," an acronym for:

Sit: Staff have a tendency to remain standing while dealing with patients and families, Dubler said, but the process should begin with all parties seated.

Tell me about Mama: Family members are more likely to be present than the patient, and Dubler has them take the lead on describing the patient's condition.

Admire: Mediators must make people feel good, Dubler said, by thanking them for taking the time to come and communicating appreciation for their insights.

Discuss what's happening: It's not enough to have one side simply lay down the facts; rather, the consultation process means a back and forth discussion.

Ask what should happen: This step doesn't always occur at the initial meeting, Dubler says, as all parties must understand all the options before discussing next steps.

Part of the problem with clinical ethics is that ethicists don't have to meet any specific educational requirements, leading the American Society for Bioethics and Humanity to establish a list of standards, FierceHealthcare previously reported.

To learn more:
- read the interview