What is Bioethics?

Bioethics is a special area of moral philosophy that generally deals in issues concerning the ways in which technology and medical decisions affect people, animals, and the environment. Typical issues in bioethics may include the value of endangered species, the ethics of genetic editing technologies (such as CRISPR-CAS9 or mitochondrial replacement therapy), the ways in which degenerative diseases affect personal identity, and how best to maximize public health and access to healthcare from a policy perspective.

What does Bioethics look like in practice?

There are many different ways of practicing bioethics. Typically, there are four ways in which one can practice bioethics:

  1. As an academic bioethicist, one conducts philosophical research into specific, theoretical topics in bioethics in order to influence policy and to discover what we ought to do as a society and as individuals. Academic bioethicists also teach classes at universities or other educational institutions.
  2. As a policy lobbyist, one attempts to influence health/environmental policy. This discipline comes in many forms, such as working for a think tank, the government, a lobbying firm, or even as an independent writer or activist. Often, bioethicists working in other disciplines (such as academia) also work as lobbyists in some capacity.
  3. As an Institutional Review Board Member, one works with research institutions to ensure that research projects are conducted ethically and in accordance with governmental or other institutional regulations.
  4. As a Clinical Ethicist, one works as a consultant for a medical institution to assist in moral dilemmas that arise in healthcare settings. Clinical ethicists attempt to resolve disputes between patients, their families, and medical teams, and may help to clarify what treatments or decisions are medically and ethically appropriate in specific cases.

I have largely worked as a clinical ethicist, though I have also dealt with issues in research and academic ethics as well.

What is an Ethics Consult?

In clinical ethics, an ethics consult occurs when a patient, family member, or clinician requests clarification of an ethical dilemma or assistance with a conflict or specific medical decision. An ethicist reviews the case and speaks to those involved, and may conduct meetings to facilitate communication and to clarify the relevant factors and policies. Typically, the ethicist makes a recommendation about how to proceed. Unless specific medical codes or laws determine a solution (such as whether or not one may receive a donor kidney, for example), the ethicist’s opinion is merely a recommendation, and patients, their families, and clinicians are not legally required to follow it.

When is an Ethics Consult appropriate?

Ethics consults are appropriate in a variety of situations. An ethics consult should be called:

  1. If there is a conflict between patients, families/decision-makers, and the care team about how to treat the patient;
  2. For assistance determining the ethically relevant decision-maker for patients who are unable to make decisions themselves;
  3. If a patient requires life sustaining treatments such as intubation, dialysis, tracheostomy, or a percutaneous endoscopic gastronomy (PEG) tube, and the patient’s wishes are unknown;
  4. If a patient is a member of a vulnerable population and does not have the means to obtain adequate healthcare;
  5. For assistance in making complex medical decisions;
  6. For help in dealing with moral distress. Moral Distress occurs when one feels that something unethical is occurring, but one is somehow unable to do the right thing or otherwise alter the situation;
  7. If a patient lacks the ability to make medical decisions and does not have an available decision-maker.

These are just a few of the situations in which an ethics consult is appropriate.

How would I call an Ethics Consult?

Ethics consults are conducted in different ways at different institutions. Some institutions review ethical dilemmas through an ethics committee, while others employ individual ethics consultants or an ethics consult service. Ask your doctor, nurse, or other healthcare professional about how ethics is conducted at your institution. Many institutions post information about their ethics services on their websites, as well.

Remeber, anyone can request an ethics consult, including patients, their families, nurses, physicians, and others.

If you have a question about this process, email me at mdauberbioethics@gmail.com!