title: Gender and Race in the Timing of Requests for Ethics Consultations: A Single-Center Study.
abstract: BACKGROUND
  Clinical ethics consultants are expected to "reduce disparities, discrimination, and inequities when providing consultations," but few studies about inequities in ethics consultation exist.1 The objectives of this study were (1) to determine if there were racial or gender differences in the timing of requests for ethics consultations related to limiting treatment, and (2) if such differences were found, to identify factors associated with that difference and the role, if any, of ethics consultants in mitigating them.
  
  
  METHODS
  The study was a mixed methods retrospective study of consultation summaries and hospital and ethics center data on 56 age-and gender-matched Caucasian and African American Medicare patients who received ethics consultations related to issues around limiting medical treatment in the period 2011 to 2014. The average age of patients was 70.9.
  
  
  RESULTS
  Consultation requests for females were made significantly earlier in their stays in the hospital (6.57 days) than were consultation requests made for males (16.07 days). For African American patients, the differences in admission-to-request intervals for female patients (5.93 days) and male patients (18.64 days) were greater than for Caucasian male and female patients. Differences in the timing of a consultation were not significantly correlated with the presence of an advance directive, the specialty of the attending physician, or the reasons for the consult request. Ethics consultants may have mitigated problems that developed during the lag in request times for African American males by spending more time, on average, on those consultations (316 minutes), especially more time, on average, than on consultations with Caucasian females (195 minutes). Most consultations (40 of 56) did result in movement toward limiting treatment, but no statistically significant differences were found among the groups studied in the movement toward limiting treatment. The average number of days from consult to discharge or death were strongly correlated with the intervals between admission to the hospital and request for an ethics consultation.
  
  
  CONCLUSIONS
  Our findings suggest race and gender disparities in the timing of ethics consultations that consultants may have partially mitigated.
authors.affiliation: Southern Illinois University School of Medicine, Department of Medical Humanities, Springfield, Illinois, USA. bspielman@siumed.edu.
authors.forename: Bethany
authors.initials: B
authors.lastname: Spielman
authors.affiliation: Memorial Medical Center, Clinical Ethics Center, Springfield, Illinois, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Gorka
authors.affiliation: University of Missouri-St. Louis, School of Education and Department of Computer Science, St. Louis, Missouri, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Miller
authors.affiliation: Southern Illinois University School of Medicine, Department of Medical Humanities, Springfield, Illinois, USA.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Pointer
authors.affiliation: Memorial Medical Center, Clinical Ethics Center, Springfield, Illinois, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hinze
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D026822:Ethicists / Q000592:standards; D033061:Ethics Consultation / Q000941:ethics / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D008875:Middle Aged; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D028761:Withholding Treatment / Q000941:ethics / Q000706:statistics & numerical data*