title: Political and interpersonal aspects of ethics consultation.
abstract: Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record.
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213-2583.
authors.forename: J E
authors.initials: JE
authors.lastname: Frader
mesh_terms: D026688:Bioethical Issues; D034462:Dissent and Disputes; D026822:Ethicists; D028741:Ethics Committees, Clinical; D033061:Ethics Consultation; D026690:Ethics, Clinical; D004992:Ethics, Medical; D006126:Group Processes; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital; D009014:Morals; D010817:Physician-Patient Relations; D028743:Professional Misconduct; D012017:Referral and Consultation / Q000639:trends*; D012941:Social Responsibility