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September 3, 2003

Answers and Questions About Ethics Consultations

Author Affiliations

Author Affiliation: Program in Medical Ethics, Division of General Internal Medicine, and Department of Medicine, University of California, San Francisco.

JAMA. 2003;290(9):1208-1210. doi:10.1001/jama.290.9.1208

Ethics consultations are touted for resolving ethical dilemmas, and most hospitals use them to meet the Joint Commission for the Accreditation of Healthcare Organizations' requirement for a process to resolve conflicts in patient care.1 Little rigorous evidence is available, however, about the outcomes of ethics consultations.2,3 In this issue of THE JOURNAL, Schneiderman and colleagues4 report a multisite randomized controlled trial to evaluate ethics consultations. The intervention, which builds on a previous single-center randomized trial,5 involved ethics consultation in the intensive care unit (ICU) for conflicts and value disagreements either among the health care team or between the team and patients or surrogates. The comparison group received standard care, in which 25% of those patients chose ethics consultation. Schneiderman et al found that patients in the intervention group who died spent 3 fewer days in the hospital, 1.4 fewer days in the ICU, and 1.7 fewer days receiving mechanical ventilation than nonsurvivors in the control group. Almost 90% of surrogates and physicians agreed or strongly agreed that the ethics consultation was helpful. The authors concluded that ethics consultations reduced nonbeneficial care without increasing mortality.

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