The managers and frontline staff on the medical/surgical unit have requested an ethics consultation. In your health authority, the ethics service uses a facilitated model of ethics consultation. Alongside an ethicist, you will facilitate a meeting with those involved and with relevant resource people. The meeting takes the format of a roundtable with a discussion between care providers, resource people, the ethicist, and you – the facilitator. Based on how the discussion goes, the group will formulate recommendations on how to proceed.
In order to determine who should be involved in the consultation, you must figure out what this case, with this complex patient, is really about. The staff on the unit know that Dora is a patient with a constellation of issues who is difficult to manage, but they can’t formulate a clear “question” (or set of questions) about their ethical duties toward Dora. Narrowing down the set of issues will help determine who to involve in this consultation.
Is this a consultation about how to stop Dora’s drug use in the hospital? Accomplishing this would require near-constant surveillance, perhaps by hospital security staff, and would mean figuring out a way to prevent her from leaving the hospital.
Is this going to be a discussion about the ethics of discharging Dora from the hospital because she poses a risk to the staff and is non-adherent to her treatment?
Is this consultation best seen as a way to involve psychiatry in her care? Dora’s denial of the obvious reality of her drug use is at the heart of the risk she poses to her caregivers. Should her addiction and denial be explored by psychiatry? Because of this refusal to admit her drug use, she will not take steps that would protect her caregivers.
Should this consultation instead be an opportunity to discuss ways to minimize risk to Dora’s caregivers? Everyone wants her to successfully complete her antibiotic treatment and recover from her infection. They recognize that being in the hospital is the most likely scenario that would lead to the success of her treatment.
Much of the activity figuring out what the ethics case is truly “about” happens before the actual consultation. You set to work.