Phoenix VA Health Care System
I’m Just not Sure… What is the Right Thing to do? Should I Ask for an Ethics Consultation?
In health care, patients and families often face the difficult question of “what should be done?” The right choice for one patient may be the wrong choice for another. If you’re unsure, or if you can’t agree with your health care team or your loved ones about what’s best, you can ask for an ethics consultation.
What is an Ethics Consultation?
Ethics consultation is a service provided by specially trained VA staff. When there is uncertainty or conflict about the right thing to do, ethics consultants work with patients, families, and staff to help them make good decisions to resolve these concerns.
Ethics consultants will not investigate complaints or allegations of misconduct. There are handled by the Patient Advocate Office.
When Should I Think about Asking for an Ethics Consultation?
Here are some examples of why Veterans and families ask for an ethics consultation:
- “I have to make a serious decision about a treatment that could affect how long I may live. After talking it over with my health care team, I am still not sure I agree with the doctor’s recommendation.”
- “My mother is too sick to make her own decisions. How do I know what is best for her now?”
- “Our family is unsure and upset. We don’t agree about the right thing to do for our brother’s care.”
The goals of our Ethics Consultation service are to:
- Have an Ethics Consultation at the earliest possible indication of conflict, struggle with decision making, or concern about patient care options.
- Improve health care quality by facilitating the resolution of ethics concerns for patients, staff and interested parties
- Provide a forum for discussion and use a method of careful analysis.
Integrated Ethics is designed to address ethics issues through CASES, a step-by-step approach to ensuring that ethics consultation is of high quality. The CASES approach was developed by the National Center for Ethics in Health Care to establish standards and systematize ethics consultation. ECWeb, a secure, web-based database tool, reinforces the CASES approach, helps ethics consultants manage consultation records, and supports quality improvement efforts. Integrated Ethics also provides assessment tools and educational materials to help ethics consultants enhance their proficiency.
The CASES Approach
- Clarify the consultation request
- Assemble the relevant information
- Synthesize the information
- Explain the synthesis
- Support the consultation process
The role of the ethics consultants are to:
- Collect Information
- Hear concerns of those involved
- Clarify various peoples role in decision-making process
- Help everyone understand the ethical issues involved
- Help the decision-makers make a plan that is consistent with personal, professional and organizational values
- Identify the ethically justifiable options
Some common misconceptions about ethics:
Ethics consults are not used to:
- Clean up a mess
- Make a treatment plan
- Tell everyone what is legal
- Tell everyone what should be done
- Rubber stamp the desires of the health care team
- Determine whether the patient is in a permanent vegetative state
- Investigate and correct a suspected wrongdoing
- Tell someone that they’re being unethical
Ethics consults are used to:
- Promote ethical practice
- Foster consensus and resolve conflict with respect
- Honor the participants' authority and values in the decision making process
- Educate participants to handle ethical issues
By envisioning new ways of looking at ethical concerns in health care, new approaches for addressing them in all their complexity, and new channels for achieving integration across the system, Integrated Ethics empowers VA facilities and staff to “do the right thing” because it’s the right thing to do.
If you would like to submit a request for an ethics consultation, please contact:
- PVAHCS Integrated Ethics Program Manager - Becky Hyduke-Rundall, LCSW
- PVAHCS Ethics Consultation Coordinator - Dr. Leonardo J. Caraballo, LCSW
- PVAHCS Preventive Ethics Coordinator - Thompsi Hoff, LCSW