title: The "Commitment Model" for Clinical Ethics Consultations: Society's Involvement in the Solution of Individual Cases.
abstract: Several approaches to clinical ethics consultation (CEC) exist in medical practice and are widely discussed in the clinical ethics literature; different models of CECs are classified according to their methods, goals, and consultant's attitude. Although the "facilitation" model has been endorsed by the American Society for Bioethics and Humanities (ASBH) and is described in an influential manual, alternative approaches, such as advocacy, moral expertise, mediation, and engagement are practiced and defended in the clinical ethics field. Our Clinical Ethics Center in Paris was founded in 2002 in the wake of the Patients' Rights Act, and to date it is the largest center that provides consultation services in France. In this article we shall describe and defend our own approach to clinical ethics consultation, which we call the "Commitment Model," in comparison with other existing models. Indeed commitment implies, among other meanings, continuity through time, a series of coherent actions, and the realization of important social goals. By drawing on a recent consultation case, we shall describe the main steps of our consultation procedure: interviews with major stakeholders, including patients and proxies; case conferences; and follow up. We shall show why we have chosen the term "commitment" to represent our approach at three different but interrelated levels: commitment towards patients, within the case conference group, and towards society as a whole.
authors.affiliation: Cochin Hospital, Centre for Clinical Ethics, 27, rue Fbg. St. Jacques, Paris 75014 France. Veronique.fournier@cch.aphp.fr.
authors.forename: Véronique
authors.initials: V
authors.lastname: Fournier
authors.affiliation: University of Versailles St-Quentin-en-Yvelines (UVSQ), Center for Clinical Ethics, Cochin Hospital, Paris, France. Marta.spranzi@club.fr.
authors.forename: Marta
authors.initials: M
authors.lastname: Spranzi
authors.affiliation: Cochin Hospital, Centre for Clinical Ethics, 27, rue Fbg. St. Jacques, Paris 75014, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foureur
authors.affiliation: University of Paris Sorbonne, Center for Clinical Ethics, Cochin Hospital, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Brunet
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods*; D003657:Decision Making / Q000941:ethics; D019988:Children with Disabilities; D004750:Enteral Nutrition; D026822:Ethicists; D033061:Ethics Consultation / Q000941:ethics*; D026690:Ethics, Clinical; D005066:Euthanasia, Passive / Q000941:ethics; D005260:Female; D005602:France; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D028681:Moral Obligations; D017008:Negotiating / Q000379:methods / Q000523:psychology; D010290:Parents / Q000523:psychology; D018802:Patient-Centered Care / Q000941:ethics*; D011218:Prader-Willi Syndrome / Q000175:diagnosis / Q000628:therapy; D012941:Social Responsibility; D012945:Social Values; D028761:Withholding Treatment / Q000941:ethics*