Bryanna Moore, PhD, Assistant Professor, Department of Bioethics and Health Humanities, UTMB School of Public and Population Health
The provision of healthcare involves many challenges, some of which require us to recognize and navigate ethical dilemmas. Many hospitals, including the UTMB system, have an entire service dedicated to helping people navigate these dilemmas.
Ethicists have a whole process that they follow, which includes gathering information from different stakeholders, identifying the ethical issues and available options, analyzing those issues and options to form a recommendation, and communicating our work up and recommendations to whoever is involved in the consult.
Over the years, we’ve learnt that many clinicians are unaware that ethics support exists in their institution. Others are aware that our service exists but unsure what function “ethics” serves in the hospital. For this month’s Faculty Group Practice newsletter, we wanted to take a moment to debunk some common myths about UTMB’s ethics service.
Myth 1: We’re the “ethics police.” Some folks assume that we’re an arm of the hospital’s legal and compliance or human resources departments, and that we are there to monitor and report instances of “wrongdoing” in the hospital.
Fact: While our work sometimes involves communicating concerns to those in leadership, the purpose of our service is to help clinicians and hospitals provide care that is medically appropriate and reflects patients’ values and preferences. In fact, sometimes our analysis involves identifying areas where policy or the law may pull us in a direction that we don’t think is the ethically preferable course and balancing ethical, legal, and institutional considerations (all of which are important!). We are one part of the multidisciplinary team and function in a supportive role—rather than as oversight.
Myth 2: Ethics assesses decision-making capacity. We sometimes receive consult requests to this effect. However, ethicists do not typically perform capacity assessments. A capacity assessment is a clinical determination made by a physician. Some ethicists are also clinicians, which can cause confusion.
Fact: There is general agreement in the field that, in our role as ethicists, it’s not appropriate for us to make this kind of determination. What we can do is help you think through your assessment of the patient’s capacity to make a certain decision by serving as a sounding board and jumping in with pertinent questions.
Myth 3: Ethics doesn’t do anything. Sometimes, folks consult us hoping that we will be able to go into a room and “change someone’s mind” or “get the DNR.” When things don’t go that way, it can feel like we were consulted and didn’t fix the situation or “do anything.”
Fact: While different consults call for different kinds of intervention, we typically do a lot of meeting with people, listening, and synthesizing information. This work is not always “visible” to those who are not present during all the steps of our work up. We practice active listening, clarify, validate, relay information, redirect, align interests, build rapport, and ideally help everyone figure out a way forward that promotes the patient’s interests.
If you think that you might need ethics assistance, you can place an Ethics Consult Order in EPIC, page us at (409) 643-9650, or call (409) 747-1230 during business hours. We are available 24/7, 365 days a year.
 | Bryanna Moore, PhD, is an Assistant Professor in the Department of Bioethics and Health Humanities, School of Public and Population Health. Visit the Bioethics and Health Humanities homepage. |