Introduction and Overview

This session will discuss pivotal cases in the historical development of clinical ethics and identify ethical conflicts that can arise in critical care.

Introduction to Clinical Ethics Deliberation

Identify the four principles of clinical ethics and discuss how conflicts between these principles can occur. This session will also cover methods for ethical problem solving.

Capacity, Competence, and Informed Consent

What is capacity and how do we distinguish it from competence? Participants will discuss advance directives, surrogates, surrogate decision making, and the different circumstances under which patients can refuse treatment.

End-of-Life Issues and Discussion

In this first session of end-of-life care, participants define end-of-life and discuss managing conflicts with surrogates as well as incomplete or conflicting documents.

End-of-Life Part Two

In this second session of end-of-life care, participants will engage in a case discussion.

Difficult Discharge

Learn how to identify and formulate a plan for unrepresented and incapacitated patients.

Boundaries and Dual Relationships

Define and identify conflicts of interest, confidentiality, and community activity.

Issues in Pediatric Practice

What is the difference between assent and consent? Delineate particular challenges around confidentiality in pediatric practice and vaccine hesitancy.

Care for Non-Capacitated Adults with Intellectual Disabilities

Discuss the medical and social models of disability plus distinguish caregiver convenience from patient benefit. Learn how to avoid bias in assessments and employ the best interests standard.

Care for Members of the LGBTQIA+ Population

This session covers health disparities, appropriate language, and issues around consent and disclosure in minor patients.

Clinical ethicists use their training in ethics, hospital policy, and mediation to help resolve conflicts of values that arise in the medical context. Sometimes conflict arises because the health care team and the patient (or the patient’s family) disagree about what the most appropriate treatment plan is. At other times, there may be genuine uncertainty about what course of treatment will best respect a patient’s prior wishes, or what course of treatment will best minimize harm to the patient. In these and other instances of values conflict or uncertainty, a clinical ethicist can help to better understand the value positions in play and facilitate discussions to arrive at conflict resolution and a plan forward.

Clinical ethicists never dictate medical care; instead, they help medical professionals, patients, and families reason through conflict or uncertainty and provide recommendations on how to proceed.

Some common reasons for consulting a clinical ethicist include:

• A patient’s family members disagree about what types of treatment an incapacitated patient would want.
• A patient is refusing a treatment that the medical team deems medically necessary.
• A member of the health care team is unsure whether a particular intervention meets the hospital’s definition of ‘futility.’
• A patient is not capable of providing consent to a procedure, but no family or friends of the patient can be located.

Not at all. Like other members of the health care team, clinical ethicists work to ensure that patients receive the best possible care and that patients, as well as their families, are supported and informed during the process. This means that clinical ethicists work collaboratively with patients, families, physicians, nurses, and other members of the health care team.

Case conferences are collegial and collaborative processes. Good ethics begins with good facts. A case is presented usually detailing:

• The presenting medical problem and course
• The stake holders involved
• The ethical conflict

A discussion then follows in which there is:

• An analysis of the conflict with potential resolutions
• Determination of a path forward that, if at all possible, is reached by consensus of the entire group.

Yes, all attendees protect confidentiality by keeping private all discussions.

For health care professionals in a variety of settings and support staff like chaplains and social workers, training in clinical ethics can help build competency and confidence in managing complex and often emotional situations that impede quality patient care. Participants in ECHO will learn to recognize ethical problems, clarify and define ethical issues, reason through solutions to those problem, and offer principled recommendations to the care team and patient. Training in clinical ethics can reduce stress and anxiety among staff by encouraging perspective-taking, communication, negotiation, and reason-giving in the face of conflicts, disagreements, and uncertainties. The ECHO model also aims to draw professionals together, building networks and supportive communities that may offer resources or advice as difficult situations arise.

Physicians, nurses, hospital administrators, chaplains, clergy members, social workers, current or prospective members of hospital ethics committees, or medical educators.