Health Care Ethics USA Archives

Summer 2026

Template Clinical Ethics Fellowship

BECKET GREMMELS, PHD
System Vice President, Theology and Ethics
CommonSpirit Health
Dallas-Fort Worth, Texas

STEVEN SQUIRES, PHD
Vice President, Ethics
CHRISTUS Health
Dallas-Forth Worth, Texas

LAURA WEBSTER, D.BIOETHICS, RN, HEC-C
Region Vice President, Ethics
CommonSpirit Health
Tacoma, Washington

ERICA LAETHEM, BEL, HEC-C
Director, Strategic Ethics Integration
OSF HealthCare
Rockford, Illinois

SAM DETERS, PHD
Manager, Mission Integration
SSM Health
St. Louis, Missouri

Clinical ethics fellowship programs serve a key function in training ethicists. They provide unique opportunities for experiential learning from an experienced practitioner that complements academic coursework, similar to preceptorships or residencies in many other healthcare professions. However, there has been little work done to formalize the structure or expectations of what ethics fellowships offer. Ellen Fox describes some attempts at such formalization elsewhere in this issue. We offer here a template curriculum for clinical ethics fellowships as one more piece of this effort to provide more rigor in practical training for ethicists.

This project grew out of a workshop at the Catholic Healthcare Innovation in Ethics Forum (CHIEF) in 2023. Participants were divided into three breakout groups to brainstorm specific elements of a fellowship curriculum: key observational opportunities, essential literature, and professions to learn about. Over the next 9 months, we met every other week to flesh out the results of that workshop into a functional template curriculum.

Clinical ethics fellows in Catholic healthcare have opportunities to serve a range of communities and expand their ethical framework and toolkit. Catholic healthcare offers unique clinical ethics fellowship experiences because of its mission and identity. Mission and Catholic identity animate a distinctive type of calling and service. These fellows benefit from the unique vocation of Catholic healthcare, even if they are uncertain about staying in Catholic healthcare. The Mission of Catholic healthcare is advanced by professionals of a diverse array of religious and faith backgrounds; it is ecumenical by nature. The communities served by many Catholic healthcare systems are pluralistic and often are not predominately Catholic. Those who work in Catholic health care embrace and celebrate these differences, exemplified in part by Directive 11 of the Ethical and Religious Directives for Catholic Health Care Services (ERDs) about responding appropriately to persons' religious beliefs or affiliation. They also draw from the strengths of these diverse life experiences to further Catholic health care's commitment to promote and protect the dignity of all, especially the most vulnerable. Ethics fellows benefit from a focus on theological understanding of clinical ethics issues. Fellows can help make and draw out connections between faith traditions or provide alternative perspectives in the absence of faith traditions. Certainly, in maintaining its religious and moral commitments, Catholic healthcare benefits from having ethicists with both fellowship experience and academic training in theology and ethics who are already formed in the intellectual tradition. Secular health care systems also benefit from fellows formed in the Catholic tradition. As one in five Americans identify as Catholic, ethics fellows from Catholic healthcare are better equipped to respond to needs of Catholic patients, families, and clinicians.

Ethics seeks to identify, unpack, and navigate values. Ethicists in Catholic health care have additional layers of moral analysis to consider, given the theological and social commitments derived from Church teaching. Fellows in Catholic health care will become adept at applying the ERDs and other Catholic teaching to individual cases. Fellows will be required to learn the ethical standards of practice, general moral norms, relevant laws and regulations which would apply in any health care context. Most healthcare facilities are not academic medical centers, yet most clinical ethics fellowships currently exist in this setting. Catholic healthcare is more representative of the diversity of care settings across the care continuum, especially community hospitals, ambulatory care, and safety net healthcare settings. While the Ethics Consultant (EC) practitioners who designed ASBH's improvement projects generally work in large teaching hospitals with high-volume Ethics Consultation Services (ECSs) (Bruce et al. 2018; Fox 2016), most general hospitals in the U.S. are quite small (50.1% have <100 beds and 71.3% have <200 beds), have no academic affiliation (61.5% are nonteaching hospitals and only 6.1% are major teaching hospitals), and perform between zero and three ECs per year (Fox et al. 2021).

Catholic health care also provides a unique setting to train ethics fellows. Catholic health care goes beyond physiological treatment by treating the whole person, with mind-body-spirit care. It creates a welcoming environment that encourages employees to be their authentic selves, including their religious beliefs, and considers how one can maintain personal, professional, and organizational integrity. Fellows contribute to the mission, formation programs, and even assessment programs like the Ministry Identity Assessment from the Catholic Health Association, which has ethics components and is unique to Catholic healthcare. Given Catholic healthcare's commitments to the poor and underserved, fellows can better experience and engage with the needs of communities.

Finally, Catholic health care offers a formational opportunity to train ethicists through clinical ethics fellowships. This is a needed pipeline not only to help form ethicists for Catholic healthcare, but also to train ethicists who might work outside Catholic healthcare to help them understand the important nuance that religious beliefs bring to medical decision making. Given the size of Catholic healthcare in the United States, there is also a potential for more fellowships than currently exist in primarily academic medical centers. Catholic health care has a great ability to contribute to this growing area of health care education.

This template is written as one example for fellowship programs to adapt as needed. Not all elements will apply to all fellowships, and not all suggestions will be feasible in all hospitals. More work also needs to be done in clinical ethics fellowships, in particular a formal assessment process to evaluate the progress of fellows towards functioning as independent ethicists after completion. We reference such an assessment but do not address it in detail as this project focused on the curriculum itself. Even still, we believe this template curriculum will help fellowship program directors in Catholic hospitals and non-Catholic hospitals as they create and revise their own curricula.

Purpose:

This one-year Clinical Ethics Fellowship is designed to provide fellows practical experience in daily clinical ethics work, including consultation services, ethics education, policy review, and ethics rounds. This program gives fellows exposure to clinical and organizational elements of healthcare. Fellows are expected to work collaboratively with Mission Integration and spiritual care while cultivating an understanding of Catholic healthcare.

Eligibility:

To be eligible to apply, prospective fellows must have a masters or doctorate degree in bioethics, theology, philosophy, or a related field.

Outcome:

The goal of the Clinical Ethics Fellowship is to provide the training and experience necessary to develop the knowledge, skills, ability, and character one should possess before entering the clinical ethics profession. Fellowship training will emphasize developing ethics consultation skills sufficient to perform independent clinical ethics consultation in acute care settings, with a focus on Catholic health care settings.

Competencies:

This fellowship is a competency-based program, organized around the following competencies:

  • Knowledge
    • Be conversant in basic concepts in healthcare finance, reimbursement, and payer strategy
  • Skills and Abilities
    • Consultation
    • Policy Development
    • Policy Review
  • Character Development and Spiritual Formation
    • Leadership
    • Ways to integrate work as a clinical ethicist and prayer life
  • Systems-Based Practice
  • Education and Scholarship
  • Presentation skills and engagement with the literature

Opportunities and Experiences:

Clinical

  • Fellows will have exposure to and integration into clinical areas to understand how clinical care works and the ethics needs of patients, clinicians, and their families.
  • The following areas are required for fellows to have exposure to. Each area can be done all at once (e.g. one week at a time) or periodically over the fellowship (one or two days a month or weekly rounds). If an area is not available at a hospital or health system, the fellow should spend time at another local hospital that offers the service. 
    • Critical Care
    • Emergency department
    • Med-Surg
    • Cardiology
    • Oncology
    • Labor and delivery
    • NICU
    • Ambulatory care
    • Operating room
  • The following areas are encouraged if available, but not required if unavailable. 
    • Pediatrics
    • PICU
    • Behavioral health
    • Skilled nursing facility
    • Home health
    • Hospice
    • Palliative care
    • Transplant
    • Nephrology
    • Advance care planning
  • In addition to clinical areas, fellows will shadow members of the following professions or roles for at least one day. 
    • Case manager
    • Nurse (direct caregiver)
    • House supervisor
    • Social worker
    • Palliative care team
    • Chaplain
    • Physician
    • Medical resident 

Organizational 

  • Fellows will have exposure to and integration into organizational areas to understand how healthcare leaders work and their ethics needs.
  • The following areas and meetings are required for the fellow to attend.
    • Safety huddle (hospital wide)
    • Quality committee
    • Medical executive committee
  • The following areas are encouraged if available, but not required if unavailable.
    • Schwartz rounds or similar event focusing on emotional support for clinicians
    • Leadership meeting with the Mission leader
    • IRB
    • Tumor board
    • Morbidity and mortality review
  • Fellows will become familiar with the health system's discernment process and participate in a discernment process if available
  • Fellows will earn how to cultivate relationships and when to contact key partner groups including: Mission integration, legal, risk management, patient experience, communications, etc.
  • Fellows will have opportunities to become familiar with hospital operations and various leadership roles including the following.
    • Shadow members of the following professions or roles as available.
      • COO
      • CMO
      • CNO
      • CFO
      • Director of case management
      • Nursing unit manager (critical care and med/surg)
      • Director of a service line such as cardiology, oncology, nephrology, etc.
      • Clinic director
      • Mission leader
    • Conduct information interviews to get to know members of hospital senior leadership, their role, and how they
    • Attend leadership meetings or create 1:1 opportunities to gain knowledge and familiarity with:
      • Basic concepts in healthcare finance, reimbursement, and payer strategy
        • For example, CHA's Mission Leader Seminar on Finance for Mission Leaders
      • Audits or reviews like TJC, internal ethics audits, CMS, or other regulatory agencies
  • Fellows will get exposure to meeting with bishops or diocesan healthcare liaisons
  • The fellow should attend meetings and shadow areas related to Mission Integration in order to be familiar with the work of a Mission leader. Examples may include:
    • Market or Region Mission Leadership meetings
    • Spiritual care rounds, including Clinical Pastoral Education (CPE) program verbatim if available
    • Formation sessions, if available
    • Community Health meetings to review the Community Health Needs Assessment (CHNA) and ongoing community health projects
    • Faith Community Nursing
    • Community Benefit program, if available

Policies

  • The fellow will become familiar with policy review and development, including the following experiences:
    • Learn how to access policies
    • Assist in ongoing policy development and revisions:
      • Revising policies in light of individual cases
      • Conducting literature reviews to identify best practices and evolving policy standards
      • Identifying stakeholders and gathering stakeholder input/ feedback
      • Review, revise, edit, or develop at least one policy and shepherd it through the approval process.

Ethics

  • Fellows will have exposure to clinical ethics experiences to develop and grow skills related to clinical ethics.
  • The opportunities required for fellows include:
    • Clinical ethics consultation
      • The following definition of clinical ethics consultation is used for this document: "Clinical ethics consultation is a service provided in response to a question (or questions) from a patient, family member, surrogate decision-maker, healthcare professional, administrator, or other involved party who seeks to resolve uncertainty or conflict regarding value-laden concerns." (Core Competencies, 2025, p 3-4)
      • Observe at least 100 hours of consultation performed by an ethicist.
      • Perform at least 100 hours of consultation while being observed by an ethicist.
      • Perform at least 100 hours of consultation independently.
      • At least 15 hours of consults in each category must include face to face interaction with a combination of the following in order to build and practice ethics facilitation skills: the patient, legally authorized decision maker, family members or loved ones, and the care team.
      • Activities that count towards the required hours include: speaking to the person who requested the consult to clarify the request, speaking to members of the care team or other ethics colleagues about the consult, speaking to the patient or their family, meeting with stakeholders, searching the literature, reviewing the chart, and writing a note in the patient's chart.
        • If the volume of ethics consults does not allow for the number of hours to be met, it can be supplemented with palliative care family meetings.
      • Participate in ethics on-call consultation service.
      • Consultation experience should vary by topic to include issues at the end of life, beginning of life, and in various departments and health disciplines.
      • Work with local ethicist on consultations regarding matters related to the ERDs, including
        • Identifying relevant Directives in particular consults
        • Discussing when the Directives might establish boundaries that may be different in non-Catholic hospitals
        • Demonstrating a working knowledge of how the Principle of Cooperation applies to commonly encountered issues
  • Regularly attend Ethics Committee meetings
  • Documentation
    • Grow from observing an ethicist document a consult in the patient's medical record, to writing a note after a consult to be reviewed with faculty and not placed in the patient's record, to documenting in the patient's record independently with later review by faculty.
    • Learn how to access and navigate the Electronic Medical Record (EMR)
    • Write one verbatim monthly from an ethics consultation or ICU rounds and debrief with faculty.
  • Conduct ethics rounds together with hospital's primary ethicist or hospital leaders to identify potential ethics needs, and grow to be able to conduct ethics rounds independently
  • Attend regular Ethics Leadership meetings
  • Attend ongoing ethics education, such as CHA webinars, external ethics education, or HEC-C training sessions
  • Attend regular Ethics Committee meetings and grow to lead or co-plan one
  • Regular meeting with VP of ethics or market ethics lead to debrief
  • Participate in employee orientation and relevant orientation for new clinicians
  • Work closely with Advance Care Planning Coordinator
  • Prepare report and analysis on ethics metrics, especially related to consultation

Education

  • Attend CHA Theology and Ethics Colloquium, CHA Assembly, or CHA Foundations for Ethicists
  • Participate in monthly CHA Ethics Webinars
  • Attend one clinical ethics conference
    • ASBH, CHIEF, APPE, Clinical Ethics Unconference, etc.
  • Provide a presentation to faculty on a research paper or a topic from academic work
  • Offer ethics education to a medical staff or department meeting
  • Dedicate 5 hours weekly to personal research and writing for academic work, as applicable (Comprehensive Exams, Dissertation, Preparation for Ethics Consultation Certification by ASBH, etc.)

Scholarship

  • Fellows will have opportunities to write and publish on topics related to clinical ethics
    • For fellows who are doctoral candidates, this could include flexibility for conducting dissertation work.

Assessment and Mentorship:

Faculty will use the following methods to assess the fellow's progress towards developing the five competencies described above. Assessments will occur periodically throughout the fellowship, including an initial and a final assessment.

  • Routine one-on-one meetings with a faculty member to discuss:
    • Overall experience
    • Clinical ethics cases
    • Feedback on professional and interpersonal skills: composure, behavior, comportment, implicit bias, ability to develop and maintain relationships with colleagues, etc.
    • Any concerns or obstacles for the fellow to meet the expectations of a fellowship graduate should be surfaced early and directly to provide the fellow the best opportunity for growth
  • Self-reflection and self-evaluation
  • Documentation of activities regularly reviewed by preceptor/fellowship director
  • Mentorship of clinical consultation skills by preceptors for clinical consultation skills, executive presence, leadership, and teaching abilities as well as feedback from the fellow
  • Clinical ethics consultation skills will be assessed according to a formal set of criteria, for example ACES, Core Competencies, the literature, or a combination of these sources. A formal assessment of the fellow's progress will occur quarterly throughout the fellowship including at the end of the fellowship
    • Assess the ability to respond to and incorporate constructive feedback

APPENDIX 1: CORE KNOWLEDGE TOPICS

The following are core topics that clinical ethics fellowship programs should focus on for improving fellows' competency.

  • End of life or severe/chronic illness issues
    • Proportionate and disproportionate means
    • Advance directives and advanced care planning
    • Brain death and working with Organ Procurement Organizations
    • Understanding palliative care and hospice
  • Reproductive issues
    • Ectopic pregnancy debate (May vs Moraczewski)
    • Direct vs. indirect abortion and the principle of double effect
  • Patient-provider relationship issues
    • Decision making capacity
    • Identifying the appropriate surrogate, including working knowledge of state law
    • Unrepresented patients
    • Informed consent
    • Shared decision making
    • Pediatric decision making; parental authority and limitations
    • General psychology around grief and trauma
  • How healthcare works
    • The role of the Ethics Committee
    • Knowing what the role of ethics is and is not
    • Professional boundaries (when you stop and someone else takes over; when to escalate)
    • Basic understanding of hospital structure (e.g. Med Exec Committee)
    • Medical and nursing training; roles in the hospital; what is a med resident
    • Basic understanding of ethics codes in other disciplines
    • HIPAA
    • Policies and procedures – how to find existing policies, skills for writing policies
    • Knowledge of Joint Commission/ Regulatory
  • Values integration
    • Catholic social teaching
    • Cooperation issues excluding M&A
  • Clinical ethics facilitation skills and tools
    • Mediation skills (e.g. Nancy Dubler and Carol Liebman)
    • Strategies for difficult and complex conversations
    • Group facilitation skills
    • Meeting management for an EC
    • Moral distress and resilience
    • EMR Documentation
    • Common pedagogy for teaching ethics relative to setting and participants
    • Self-awareness of biases
  • Vulnerable populations
    • Behavioral health
    • People who are incarcerated or formerly incarcerated
    • People experiencing homelessness
    • Minors
    • Unrepresented
    • Immigrants and persons who are undocumented
    • Self-pay, those without insurance
    • Cultural and religious issues
    • Common faith norms of religious and cultural groups.
  • Research ethics
    • Research vs experimentation
    • Optimism bias
  • Key legal cases
    • Dax Cowart
    • Henrietta Lacks
    • Nancy Cruzan
    • Jahi McMath
    • Other issues unique to the legal jurisdiction of the fellowship program
  • Additional Topics

APPENDIX 2: LIST OF CURRICULUM DOCUMENTS

The following is a list of core articles and literature to review with clinical ethics fellows during their fellowship. These are the references that fellows would be expected to be generally familiar with, or would be helpful for faculty to refer to while teaching the core knowledge topics. A fellow would not necessarily be expected to thoroughly read every item on this list during the fellowship. This list is not comprehensive; other sources may be needed and used. They are grouped by category but are not listed in order of importance.

Key articles and literature 

Magisterial Teaching

  • Ethical and Religious Directives for Catholic Healthcare Services (ERDs), United States Conference of Catholic Bishops, 7th Edition, 2025.
  • Address of His Holiness John Paul II to the Leaders in Catholic Health Care (September 14, 1987) in Phoenix
  • Note on the Morality of Some Anti-Covid-19 Vaccines (December 21, 2020) Congregation for the Doctrine of the Faith
  • Dignitas personae (June 20, 2008) Congregation for the Doctrine of the Faith
  • Responses to Certain Questions of the United States Conference of Catholic Bishops concerning Artificial Nutrition and Hydration, with Commentary (August 1, 2007) Congregation for the Doctrine of the Faith
    • Congregation for the Doctrine of the Faith Commentary
  • Address to the Participants in the International Congress on Life-Sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas (March 20, 2004) Pope John Paul II
  • Address to the Eighteenth International Congress of the Transplantation Society (August 29, 2000) Pope John Paul II
  • Moral Principles concerning Infants with Anencephaly (September 19, 1996) Committee on Doctrine National Conference of Catholic Bishops (U.S.)
  • Evangelium vitae, "The Gospel of Life," (March 25, 1995) Pope John Paul II
  • Responses to Questions Proposed concerning "Uterine Isolation" and Related Matters (July 31, 1993) Congregation for the Doctrine of the Faith
  • Nutrition and Hydration: Moral and Pastoral Reflections (1992) Committee for Pro-Life Activities National Conference of Catholic Bishops (U.S.)
  • Donum vitae, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (February 22, 1987) Congregation for the Doctrine of the Faith
  • Declaration on Euthanasia (May 5, 1980) Congregation for the Doctrine of the Faith
  • Quaecumque sterilizatio, Responses on Sterilization in Catholic Hospitals (March 13, 1975) Congregation for the Doctrine of the Faith
  • Declaration on Procured Abortion (November 18, 1974) Congregation for the Doctrine of the Faith
  • Humanae vitae (July 25, 1968) Pope Paul VI
  • "The Prolongation of Life," Address to an International Congress of Anesthesiologists (November 24, 1957) Pope Pius XII
  • Dignitas infinita, 2024 CDF
  • Samaritanus bonus, 2020, CDF
  • Veritatis splendor, Pope St. John Paul II
  • USCCB Doctrinal Note on transgender issues
  • The New Charter for Healthcare Workers, Pontifical Council for Health Care Workers, 2016

Catholic Bioethics

  • Striving for Excellence in Ethics, Catholic Health Association, 2014.
  • Pope Francis and the Transformation of Health Care Ethics
  • Contemporary Catholic Health Care Ethics, 2nd edition
  • Catholic Bioethics and the Gift of Human Life by William May
  • Hamel, Ron. Early Pregnancy Complications and the ERDs. Health Care Ethics USA. 2014, 22:1.
  • Lysaught, M. Therese. Respect: Or, How Respect for Persons Became Respect for Autonomy. Journal of Medicine and Philosophy. 2006, 29:6.
  • Moraczewski, Albert. Ectopic Pregnancy Revisited. Ethics & Medics, 1998, 23:3.
  • Derse, Arthur R., David Schiedermayer. Practical Ethics for Students, Interns, and Residents. 4th edition, 2017.
  • Family dynamics – L. Maitland, "Taking Families Seriously in Patient Care," Trinity Health Ethics Institute, 2012, available because of permission from Trinity Health and L. Maitland's next-of-kin; Psychology Today Staff, "Understanding Family Dynamics," available at https://www.psychologytoday.com/us/basics/family-dynamics.
  • Negotiation literature (in addition to Getting to Yes) – D. Shapiro, Negotiating the Nonnegotiable, reprint ed., New York, NY: Penguin Books, 2017; C. Voss, Never Split the Difference: Negotiating as if Your Life Depended on It, Harper Business, 2016; S. Finder and M. Bilton, eds., Peer Review, Peer Education, and Modeling in the Practice of Clinical Ethics Consultation: The Zadeh Project, Springer Cham, 2018.
  • Health care continuum of care, finance, and operations – sources (an operations coach?) L. Shi and D. Singh, Delivering Health Care in America, 8th ed., Burlington, MA: Jones & Bartlett Learning, 2022; E. Askin and N. Moore, The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System, St. Louis, MO: Washington University in St. Louis, 2012; R. Pearl, Uncaring: How the Culture of Medicine Kills Doctors & Patients, New York, NY: Public Affairs, 2021; J. Wolff, Ethics and Public Policy: A Philosophical Inquiry, 2nd ed., New York, NY: Routledge, 2020.
  • J. Glaser, "Catholic Health Ministry: Fruit on the Diseased Tree of U.S. Health Care," Health Care Ethics USA 15, no. 1.
  • M. McDonough, Can a Health Care Market be Moral? A Catholic Vision, Washington, D.C.: Georgetown University Press, 2007
  • J. Renken, Church Property: A Commentary on Canon Law Governing Temporal Goods in the United States and Canada, Staten Island, NY: Alba Hourse, 2009.
  • Moral distress and moral injury – C. Rushton, Moral Resilience: Transforming Moral Suffering in Healthcare, New York, NY: Oxford University Press, 2018; E. Nagoski and A. Nagoski, Burnout – The Secret to Unlocking the Stress Cycle, New York, NY: Ballantine Books, 2019.
  • Leadership and leadership training – R. Jones, "The Family Dynamics We Grew Up with Shape How We Work," Harvard Business Review, available at https://hbr.org/2016/07/the-family-dynamics-we-grew-up-with-shape-how-we-work.
  • Organizational ethics (business ethics) – K. Goodpaster, "Business Ethics and Stakeholder Analysis," Business Ethics Quarterly 1, no. 1; G. Magill, "Organizational Ethics in Catholic Health Care: Honoring Stewardship and the Work Environment," Christian Bioethics 7, no.1; Markkula Center for Applied Ethics at Santa Clara University, Business and Organizational Ethics webpage, available at https://www.scu.edu/ethics/focus-areas/business-ethics/resources/articles/.
  • Organizational dynamics, politics, and behaviors – GreggU, "Organizational Behavior," YouTube, available at https://youtu.be/QJAv6674_Sw?si=NzHLDFBpYq0ldS-P; GreggU, "Organizational Dynamics and Behavior," YouTube, available at https://youtu.be/AU1PMNPy_vI?si=IP2JEIkYHeGe3TtR;
  • Basic medical terms and language – American Institute of Medical Science and Education, "All Essential Medical Terms in One Place," 2022, available at https://aimseducation.edu/blog/all-essential-medical-terms; Harvard Medical School, "Medical Dictionary of Health Terms," 2011, available at https://www.health.harvard.edu/a-through-c; St. George's University School of Medicine, "75 Must-Know Medical Terms, Abbreviations, and Acronyms," 2021, available at https://www.sgu.edu/blog/medical/medical-terms-abbreviations-and-acronyms/.
  • Whom is responsible for what? – (Covered in The Health Care Handbook)
  • Public speaking, education, and adult learning – BrightMorning, "The Principles of Adult Learning," available at https://brightmorningteam.com/wp-content/uploads/2019/08/Principles-of-Adult-Learning.pdf; Cornerstones Education Limited, "The Six Steps of Curriculum Design," infographic, available at https://cornerstones--live.s3.eu-west-2.amazonaws.com/uploads/2021/07/19092736/The-six-steps-of-curriculum-design-ENGLAND-UPDATED-JUL21-2.pdf; C. Gallo, Talk Like TED – The 9 Public-Speaking Secrets of the World's Top Minds, New York, NY: St. Martin's Press, 2014; M. North, "10 Tips for Improving Your Public Speaking Skills," Professional Development, Harvard Division of Continuing Education, 2020, available at https://professional.dce.harvard.edu/blog/10-tips-for-improving-your-public-speaking-skills/; J. Stark and L. Lattuca, "Academic Plan," diagram.
  • Tourism Academy, "Adult Learning Realities: An Infographic," available at https://blog.tourismacademy.org/infographic-the-reality-of-adult-learning; Western Governors University, "10 Simple Principles of Adult Learning," 2020, available at https://www.wgu.edu/blog/adult-learning-theories-principles2004.html#close.
  • Other modes (podcasts, TED talks, online training) – "W;t" movie; MasterClass "Organizational Ethics: Examples of Ethical Business Practices," available at https://www.masterclass.com/articles/organizational-ethics.
  • A work that describes the heritage and founding of Catholic healthcare in the US, either one that is unique to the founding congregation(s) of the health system or one that discusses Catholic healthcare in general, for example
    • Mann-Wall, Barbra. Unlikely Entrepreneurs: Catholic Sister and the Hospital Marketplace, Catholic Health Association, 2021.
    • Williams, Shannon Dee. Subversive Habits: Black Catholic Nuns in the Long African American Freedom Struggle, Duke University Press Books, 2022.
    • Farren, Suzy. A Call to Care: The Women Who Build Catholic Healthcare in America, Catholic Health Association, 1996.
  • Gaillardetz, Richard R. By What Authority?: Foundations for Understanding Authority in the Church. Liturgical Press, 2018.
  • B. Ashley, J. DeBlois, and K. O'Rourke, Health Care Ethics: A Catholic Theological Analysis, 5th ed., Washington, D.C.: Georgetown University Press, 2006.
  • K. O'Rourke, T. Kopfensteiner, and R. Hamel. "A Brief History – A Summary of the Development of the Ethical and Religious Directives for Catholic Health Care Services," Health Progress 82, no. 6.

Intro to Clinical Ethics

  • Fletcher's Introduction to Clinical Ethics, 3rd edition
  • A. Derse and D. Schiedermayer. Practical Ethics for Students, Interns, and Residents: A Short Reference Manual, 4th ed., Hagerstown, MD: University Publishing Group, 2017.
  • Resolving Ethical Dilemmas: A Guide for Clinicians, 5th edition
  • Addressing Patient-Centered Ethical Issues in Health Care: A Case-Based Study Guide
  • Improving Competencies in Clinical Ethics Consultation: An Education Guide, 2nd edition
  • Core Competencies for Healthcare Ethics, 2nd edition
  • McCarthy M, Homan M, Rozier M. There's no harm in talking: Re-establishing the relationship between theological and secular bioethics. The American Journal of Bioethics. 2020;20(12):5-13. doi:10.1080/15265161.2020.1832611 (8 pages)
  • Loyola University Chicago, Neiswanger Institute for Bioethics, "The Assessing Clinical Ethics Skills (ACES) Project," available at https://lucapps.luc.edu/clinicalethicsdemo/aces.htm.
  • Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants (5 pages)
  • The Zadeh Project – A Clinical Ethics Consultation Narrative: The Zadeh Scenario (23 pages) (p 19-42)
  • O'Toole B. Four ways people approach ethics. A practical guide to reaching consensus on moral problems. Health Prog. 1998 Nov-Dec;79(6):38-41, 43. PMID:10339231. (5 pages)
  • Ruston, CH (2009) The Art of Pause AACN Advanced Critical Care. 20-1, p108-111 (4 pages)
  • Optional Readings
  • The Zadeh Project – A Frame for Understanding the Generative Ideas, Formation, and Design (p 1-15) (15 pages)
  • Lanphier E, Anani UE. Trauma Informed Ethics Consultation. Am J Bioeth. 2022 May;22(5):45-57. doi:10.1080/15265161.2021.1887963. Epub 2021 Mar 8. PMID: 33684027.
  • G. McGee, A. Caplan, J. Spanogle, et al., "A National Study of Ethics Committees," American Journal of Bioethics 1, no. 4.;
  • C. Crico, V. Sanchini, P. Casali, et al., "Evaluating the Effectiveness of Clinical Ethics Committees: A Systematic Review," Medicine, Health Care and Philosophy 24.
  • Fox, Ellen, Marion Danis, Anita J. Tarzian, and Christopher C. Duke. "Ethics consultation in US hospitals: a national follow-up study." AJOB 22, no. 4 (2022):5-18.

Beginning of Life

  • Kaempf, J. W., & Dirksen, K. (2017). Extremely premature birth, informed written consent, and the Greek ideal of sophrosyne. Journal of Perinatology: Official Journal of the California Perinatal Association. https://doi.org/10.1038/s41372-017-0024-4 (3 pages)
  • Leuthner, S. R., & Acharya, K. (2020). Perinatal Counseling Following a Diagnosis of Trisomy 13 or 18: Incorporating the Facts, Parental Values, and Maintaining Choices. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 20(3), 204–215. https://doi.org/10.1097/ANC.0000000000000704 (11 pages)
  • Hamel R. Early pregnancy complications and the ERDs. Health Care Ethics USA. 2014;22(1):1-13. (12 pages)
  • Leuthner, S. R. (2014). Borderline Viability: Controversies in Caring for the Extremely Premature Infant. Clinics in Perinatology, 41(4), 799–814. https://doi.org/10.1016/j.clp.2014.08.005

Conflicts of Interest

  • Weiss EM, Wightman A, Webster L, Diekema D. Conflicts of interest in clinical ethics consults. J Med Ethics. 2020 Dec 21:medethics-2020-106725. doi: 10.1136/ medethics-2020-106725. Epub ahead of print. PMID: 33443116. (7 pages)
  • Magelssen M. When should conscientious objection be accepted? J Med Ethics. 2012 Jan;38(1):18-21. doi: 10.1136/jme.2011.043646. Epub 2011 Jun 20. PMID: 21690230. (2 pages)
  • Blackhall LJ, Frank G, Murphy S, Michel V. Bioethics in a different tongue: the case of truth-telling. J Urban Health. 2001 Mar;78(1):59-71. doi: 10.1093/ jurban/78.1.59. PMID: 11368203; PMCID: PMC3456201. (12 pages)

Culture and Religion

  • Rady, M. Y., & Verheijde, J. L. (2015). The Determination of Quality of Life and Medical Futility in Disorders of Consciousness: Reinterpreting the Moral Code of Islam. The American Journal of Bioethics, 15(1), 14–16. (3 pages)
  • Sulmasy, D. P. (2007). Distinguishing denial from authentic faith in miracles: a clinical-pastoral approach. Southern Medical Journal, 100(12), 1268–1272. https://doi.org/10.1097/SMJ.0b013e3181583b7b
  • Lessons for a "Goses"
  • Searlight, RH., and Gafford, J. (2005) Cultural Diversity at the End of Life: Issues and Guidelines for Family Physicians. American Family Physician Journal. 71(3) 515-522

Dignity of Risk and Vulnerabilities

  • Tan ZS. A piece of my mind. The "right" to fall. JAMA. 2010 Jun 16;303(23):2333-4. doi: 10.1001/jama.2010.792. PMID:20551398. (2 pages)
  • Schreiber N, Powell T, O'Dowd MA. Who Should Decide? Residence Capacity Evaluation of a Cognitively-Impaired Older Adult Requesting an "Unsafe" Discharge to Home. Psychosomatics. 2018 Nov;59(6):612-617. doi: 10.1016/j.psym.2018.03.004. Epub 2018 Mar 21.PMID: 29754723. (5 pages)
  • Boldt, J. (2019). The concept of vulnerability in medical ethics and philosophy. Philosophy, Ethics, and Humanities in Medicine, 14(1), 6. https://doi.org/10.1186/s13010-019-0075-6 (8 pages)
  • Boyle PJ. The church and diversity. Catholic social teaching provides a firm basis for following the principle of inclusion. Health Prog. 2003;84(3):44-47. (4 pages)
  • Jaycox MP. The Black Lives Matter Movement: Justice and Health Equity. Health Prog. 2016;97(6):42-47. (6 pages)

Implied Consent and Substitute Decision Makers

  • AMA J Ethics. 2020;22(5):E358-364. doi:10.1001/amajethics.2020.358. Sliding scale shared decision making patients with reduced capacity (~2-3 pages)
  • Howe, E. G. (2014). New approaches with surrogate decision makers. The Journal of Clinical Ethics, 25(4), 261–272. (?11? pages)
  • West, J. C. (2020). What Is an Ethically Informed Approach to Managing Patient Safety Risk During Discharge Planning? AMA Journal of Ethics, 22(11), 919–923. https://doi.org/10.1001/amajethics.2020.919 (4 pages)
  • Curtis JR, Burt RA. Point: the ethics of unilateral "do not resuscitate" orders: the role of "informed assent". CHEST. Vol 132. United States 2007:748-751; discussion 755-746. (3 pages)
  • Simkulet, W. (2019). Informed consent and nudging. Bioethics, 33(1), 169–184. https://doi.org/10.1111/bioe.12449 (16 pages)
  • Review hospital Informed Consent policy: Specifically definition of "Emergent"

Informed Consent, Capacity, and Shared Decision Making

  • VA Ethics Committee. Ten Myths about Decision Making Capacity. 2002.
  • Appelbaum PS, Grisso T. Assessing patients' capacities to consent to treatment. N Engl J Med. 1988 Dec 22;319(25):1635-8. doi:10.1056/NEJM198812223192504. (5 pages)
  • Annas, G. J. (2017). Informed consent: charade or choice? Journal of Law, Medicine & Ethics, 45(1), 10–12. https://doi.org/10.1177/1073110517703096 (2 pages)
  • https://www.the-hospitalist.org/hospitalist/article/124731/how-do-i-determine-if-my-patient-has-decision-making-capacity/3/ (~1 page)
  • Barina R, Trancik E. From call to consult: A strategy for responding to an ethics request. Health Care Ethics USA. 2013;21(4):22-27. (~2-3 pages)
  • Bhang TN, Iregui JC. Creating a climate for healing: a visual model for goals of care discussions. J Palliat Med. 2013 Jul;16(7):718. doi: 10.1089/ jpm.2012.0633. Epub 2013 May 15.PMID: 23676097. (2 pages)
  • Pope, T. M. (2017). Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law. The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics, 45(1), 12–40. https://doi.org/10.1177/1073110517703097 (18 pages)
  • Spike, J. P. (2017). Informed consent is the essence of capacity assessment. Journal of Law, Medicine & Ethics, 45(1), 95–106. https://doi.org/10.1177/1073110517703103 (10 pages)

Informed Assent and Non-Dissent

  • Curtis JR, Burt RA. Point: the ethics of unilateral "do not resuscitate" orders: the role of "informed assent". CHEST. Vol 132. United States 2007:748-751; discussion 755-746.
  • Kon AA. Informed non-dissent: a better option than slow codes when families cannot bear to say; let her die. Am J Bioeth. 2011;11(11):22-2
  • Curtis JR, Kross EK, Stapleton RD. The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). JAMA. Published online March 27, 2020. doi:10.1001/jama.2020.4894
  • Stapleton RD, Ford DW, Sterba KR, Nadig NR, Ades S, Back AL, Carson SS, Cheung KL, Ely J, Kross EK, Macauley RC, Maguire JM, Marcy TW, McEntee JJ, Menon PR, Overstreet A, Ritchie CS, Wendlandt B, Ardren SS, Balassone M, Burns S, Choudhury S, Diehl S, McCown E, Nielsen EL, Paul SR, Rice C, Taylor KK, Engelberg RA. Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients. J Pain Symptom Manage. 2022 Jun;63(6):e621-e632. doi: 10.1016/j.jpainsymman.2022.03.009. PMID: 35595375; PMCID: PMC9179950
  • Clark JD, Dudzinski DM. The culture of dysthanasia: attempting CPR in terminally ill children. Pediatrics. 2013 Mar;131(3):572-80. doi: 10.1542/peds.2012-0393. Epub 2013 Feb 4. PMID:23382437.

Moral Distress and Resilience

  • Dudzinski DM. Navigating moral distress using the moral distress map. J Med Ethics. 2016 May;42(5):321-4. doi: 10.1136/medethics-2015-103156. Epub 2016 Mar 11. PMID: 26969723. (4 pages)
  • Morley G, Bradbury-Jones C, Ives J. What is 'moral distress' in nursing? A feminist empirical bioethics study. Nurs Ethics. 2020 Aug;27(5):1297-1314. doi: 10.1177/0969733019874492. Epub 2019 Sep 29. PMID: 31566094; PMCID:PMC7406988 (15 pages)

Not Medically Appropriate and Medical Futility

  • J. Burns and R. Truog, "Futility: A Concept in Evolution," CHEST 132, no. 6.
  • Gabriel T. Bosslet, Thaddeus M. Pope, Gordon D. Rubenfeld, Bernard Lo, Robert D. Truog, Cynda H. Rushton, J. Randall Curtis, Dee W. Ford, Molly Osborne, Cheryl Misak, David H. Au, Elie Azoulay, Baruch Brody, Brenda G. Fahy, Jesse B. Hall, Jozef Kesecioglu, Alexander A. Kon, Kathleen O. Lindell, and Douglas B. White An Official ATS/AACN/ACCP/ESICM/ SCCM. Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units. American Journal of Respiratory and Critical Care Medicine 2015 191:11, 1318-1330 (11 pages)
  • Kon AA, Shepard, E. K., Sederstrom, N. O., Swoboda, S. M., Marshall, M. F., Birriel, B., & Rincon, F. (2016). Defining futile and potentially inappropriate interventions: A policy statement from the Society of Critical Care Medicine Ethics Committee. Critical Care Medicine, 44(9), 1769-1774.doi: 10.1097/CCM.0000000000001965 (5 pages)
  • Downer K, Gustin J, Lincoln T, Goodman L, Barnett MD, How I Do It: Communicating around Time Limited Trials, CHEST (2021), doi: https://doi.org/10.1016/j.chest.2021.08.071. (6 pages)
  • Catholic Health Association of the United States. Teachings of the Catholic Church on Caring for People at the End of Life. Catholic Health Association of the United States; 2022. (15 pages)
  • Bertino, J., & Potter, J. (2020). Requiring Consent for Brain-Death Testing: A Perilous Proposal. The American Journal of Bioethics, 20(6), 28–30. https://doi.org/10.1080/15265161.2020.1754515 (2 pages)
  • Panicola MD, Hamel R. Enhancing Communication and Coordination of Care: A "Third Generation" Approach to Medical Futility. Health Care Ethics USA. 2012;20(1):9-21. (6 pages)
  • Hamel RP, Panicola MR. Are futility policies the answer? Caregivers must improve communication with patients and their families. Health Progress. 2003;84(4):21-24. (~2 pages)
  • Sulmasy, D. P., & Courtois, M. A. (2019). Unlike Diamonds, Defibrillators Aren't Forever: Why It Is Sometimes Ethical to Deactivate Cardiac Implantable Electrical Devices. Cambridge Quarterly of Healthcare Ethics, 28(2), 338–346. https://doi.org/10.1017/S096318011900015X (7 pages)
  • Schneiderman, LJ & Jecker, NS. The Abuse of Futility. Perspectives in Biology and Medicine 60;3 295-313, 2017 (19 pages)

Pain Medication

  • U.S. Supreme Court: Vacco v. Quill, 521 U.S. 793 (1997).
  • Statutory protection: California Business and Professional Code, Sections 2190.5, 2241.6, and 2313; 2004.
  • Case law precedents: North Carolina Superior Court Division. Estate of Henry James v. Hillhaven Corporation No. 89, 1991
  • Bergman v Wing Chin, MD and Eden Medical Center, No. H205732-1 (Cal App Dept Super Ct 1999)
  • International: Lohman D., Schleifer R., Amon J.J. Access to pain treatment as a human right. BMC Med. 2010; 20: 8
  • World Health Organization National cancer control programmes: Policies and management guidelines. 2nd ed. WHO, Geneva, Switzerland 2002

Risks of Prolonged Hospitalization

  • Jankowski JJ, Seastrum T, Swidler RN, Shelton W: For lack of a better plan: a framework for ethical, legal, and clinical challenges in complex inpatient discharge planning. HEC Forum 2009; 21(4):311–326
  • Brindle N, Holmes J: Capacity and coercion: dilemmas in the discharge of older people with dementia from general hospital settings. Age & Aging 2005; 34(1):16–20
  • Creditor MC: Hazards of hospitalization of the elderly. Ann Intern Med 1993; 118(3):219–223

Operational Effectiveness

  • Local organizational policies
  • Team of Teams" New Rules of Engagement for a Complex World
  • Heroic Leadership: Best Practices from a 450-year-Old Company
  • Disarming the Narcissist: Surviving and Thriving with the Self-Absorbed by Wendy Behary et al.
  • Crucial Conversations: Tools for Talking When Stakes Are High by Kerry Patterson et al.
  • G. Glen, M. Kofler, and K. O'Connor, Handbook for Ministers of Care, 2nd ed., Chicago, IL: Liturgy Training Publications, 1997.
  • C. Headlee, "10 Ways to Have a Better Conversation," TEDx Creative Coast, available at https://www.ted.com/talks/celeste_headlee_10_ways_to_have_a_better_conversation?utm_+source=tedcomshare.
  • R. Fisher, W. Ury, and B. Patton, Getting to Yes: Negotiating Agreement Without Giving In, updated edition, New York, NY: Penguin Books, 1991.

Download Article PDF

Copyright © 2026 by the Catholic Health Association of the United States
For reprint permission, please contact copyright@chausa.org.

Copyright © 2024 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.
CHA Publications

Reprint Requests

Would you like permission to reprint an article from one of CHA's publications? To do so, please use our online request form. Please allow our team 1-2 business days to respond to your request.
Reprint Request Form