title: What Ethical Issues Really Arise in Practice at an Academic Medical Center? A Quantitative and Qualitative Analysis of Clinical Ethics Consultations from 2008 to 2013.
abstract: As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male (55.8 %), white (57.1 %), between 50 and 69 years old (38.5 %), of non-Hispanic origin (85.9 %), and of Roman Catholic faith (43.6 %). Nearly half (47.4 %) were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making (93.6 %), goals of care/treatment (80.8 %), and end-of-life (73.1 %). More specifically, capacity (57.1 %), patient's wishes/autonomy (54.5 %), and surrogate decision maker (51.3 %) were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment (12.8 %), patient wishes/autonomy (12.2 %), and capacity (11.5 %). Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field.
authors.affiliation: The Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, 2160 S. 1st Avenue, Bldg. 120, Room 280, Maywood, IL, 60153, USA. kawasson@luc.edu.|The Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, 2160 S. 1st Ave., Bldg. 120, Rm. 284, Maywood, IL, 60153, USA. kawasson@luc.edu.
authors.forename: Katherine
authors.initials: K
authors.lastname: Wasson
authors.affiliation: The Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, 2160 S. 1st Avenue, Bldg. 120, Room 280, Maywood, IL, 60153, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Anderson
authors.affiliation: Loyola University Medical Center, 2160 S. 1st Avenue, Bldg. 120, Room 280, Maywood, IL, 60153, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Hagstrom
authors.affiliation: The Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, 2160 S. 1st Avenue, Bldg. 120, Room 280, Maywood, IL, 60153, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: McCarthy
authors.affiliation: The Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, 2160 S. 1st Avenue, Bldg. 120, Room 280, Maywood, IL, 60153, USA.
authors.forename: Kayhan
authors.initials: K
authors.lastname: Parsi
authors.affiliation: The Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, 2160 S. 1st Avenue, Bldg. 120, Room 280, Maywood, IL, 60153, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Kuczewski
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003657:Decision Making / Q000941:ethics*; D033061:Ethics Consultation / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012189:Retrospective Studies
keywords: Clinical ethics consultants; Clinical ethics consultation; Quality attestation; Retrospective review