Ethics Consultation Service

The ethical dilemmas that occur in the practice of anesthesiology may be difficult for the practitioner to resolve alone.^[188] Ethics committees and their consulting services act in an advisory role to help caregivers, patients, and families amicably resolve ethical dilemmas.^{[189] [190]} Anesthesiologists may find ethics consultation helpful with questions about informed consent, decision-making capacity, resuscitation decisions, and resolving disagreements among patients, families, and caregivers. ^{[191] [192]} Ethics consultants may be helpful in providing increased clinical clarity, increased moral or legal clarity, motivation to do what they believe is right, facilitation of the process of decision-making, implementation of a decision, interpretation of technical language, and consolation and support.^[193] After consultations, clinicians feel greater satisfaction in managing cases with ethical conflicts, not only because of their heightened awareness of the expert consulting services available, but also because of their increased knowledge and comfort in dealing with these issues.^{[191] [194] [195]} Interviews conducted with patients or surrogates after ethics consultations revealed that most interviewees found the consultation helpful and that less than 5% found them harmful.^[193] Proactive ethics consultations instituted before the development of an ethical dilemma improved communication and reduced length of stay in the intensive care unit.^[196] Ethics committees are also available to consult on policy development and to organize continuing educational programs.^[197]

The ethics facilitation approach, identified by a respected ethics consultation consortium as the most appropriate technique for ethics consultation in the United States, centers on "identifying and analyzing the nature of the value uncertainty and facilitating the building of consensus."^[198] Consensus may be defined in terms of outcome or process of reaching an outcome. Consultants do this by gathering data; clarifying concepts; clarifying the normative roles of society's values, law, ethics, and institutional policy; and identifying a range of morally acceptable options.^[198]