Hi. I'm Art Caplan, at the Division of Medical Ethics at the NYU Grossman School of Medicine. I had an interesting case presented to me recently by a member of an ethics committee, not at NYU, but at another hospital in another state. That committee, of which this woman was a member, had been consulted about a case involving a very sick, almost terminally ill young woman.
The doctors who were caring for her thought they were going to reach a point where interventions to try to help her would become futile and where her suffering was going to be extreme. Maybe they could control it with drugs and medication, but they'd almost have to knock her out completely in order to handle the pain and suffering she had from a widespread cancer that was ravaging her.
The doctors involved in the care sought a consult with the ethics committee at this hospital. They basically asked their opinion. Did they think it was legitimate to stop care, even if the family did not agree, because it looked to them like it was going to become in the best interests of this patient to do so? What sort of disclosures should they make? How should they manage a situation in which they had reason to believe that the family might not be cooperative in any conversation or any plan to terminate treatment and let the young woman die?
The question that the ethics committee member had for me was, because they requested the consult, did the ethics committee or anybody at the hospital have a duty to disclose to the family or the patient that a consult had been sought?
I actually didn't know the answer to this question. Do people who consult with ethics committees have an obligation, legal or moral, to let others know that a consult has been requested by doctors or nurses? Do they have to tell family? Do they have to tell patients? Is there anybody else they have to tell?
It turns out that the answer to this question — if you were to consult an ethics committee or call for an ethics consultation — is no, you don't have to disclose the request if you ask for ethics advice.
If you're doing what is sometimes called a curbside consult — where you're just saying, give me your opinion, I'll weigh it, and it's something I'm going to take into consideration in caring for a patient or our team will take into consideration — you don't actually have to tell the patient or anybody else that you're seeking outside advice.
There's no legal obligation. There are no laws I could find. Morally, you're just asking for an opinion, which ultimately you're going to weigh, accept, or not take into account.
The only difference is, if the ethics committee is asked to do a formal mediation with a family or a patient, then obviously, they have to know that a mediation is going to happen. The committee will listen to various accounts of what is being disputed and may render an opinion. A formal dispute resolution, yes.
If you're going to put a note that an ethics committee opinion was sought into a chart, then that could become known to the patient and family because they have the right to see their medical records.
If there's no note and no formal dispute resolution invoked, it turns out that you can ask for ethics advice without having to notify anyone except the people who, if you will, are waiting to get the advice back from the committee.
There is no obligation and no duty to disclose that I can see to the patient or family. That may bring you more comfort and may make it a little bit easier to consider getting an opinion from an ethics consult or an ethics committee because you don't have to worry so much about who else is going to know.
I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thank you for watching.
Note: This article originally appeared on Medscape.
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