Ethics consultation is receiving increased attention of late. The October 2009 issue of Cambridge Quarterly of Healthcare Ethics contains a special section devoted to ethics consultation: "Coming of Age in Clinical Ethics Consultation: Time for Assessment and Evaluation."

The first article is of particular interest. George Agich discusses "Why Quality Is Addressed So Rarely in Clinical Ethics Consultation." At one point in the article he says: "Obviously, the kinds of questions or cases that are brought to ethics consultation services within certain institutions are structured by the nature of those institutions, the interests and concerns of those who request ethics consultations, as well as the overall clinical culture within which the service functions. Identifying the processes whereby cases and questions are brought to the ethics consultation service and the processes or procedures by which ethics consultants respond within each setting is a natural target for improving the quality of the services provided" (345).

Also addressing ethics consultation and quality, but with a different yet related focus, is an article in the fall 2009 issue of The Journal of Clinical Ethics (vol. 20, no. 3, pp. 220-226). The article, authored by Douglas Opel, Dena Brownstein, Douglas Diekema, Benjamin Wilfond, and Robert Pearlman, is titled "Integrating Ethics and Patient Safety: The Role of Clinical Ethics Consultants in Quality Improvement." The authors observe that "Much of the attention on quality in ethics has focused on improving the internal structures and processes within ethics consultation services, including the competencies of consultants themselves. However, in the wake of the proposal from the Institute of Medicine (IOM) that all care should be safe, effective, patient-centered, timely, efficient, and equitable, we challenge ethics consultants to look beyond the traditional confines of clinical ethics and contribute to this goal. This broader focus would act in conjunction with current efforts to improve the quality of practice within ethics consult services, but would strive primarily to improve the quality of health care provided throughout the system" (221). The remainder of the article goes on to discuss how this might be done.

Together with calls to improve ethics consultation with quality are tools for doing so. The second part of the VA's Integrated Ethics program ("Preventive Ethics: Addressing Ethics Quality Gaps on a Systems Level") offers an approach and helpful tools for using ethics consultation for systemic change (see www.ethics.va.gov/integratedethics/index.asp). The VA has also developed ECWeb which is described as "a web-based tool that plays an important role in helping VHA achieve the goal of improving ethics quality within VA (see www. ethics.va.gov/integratedethics/ECWeb.asp). Mark Repenshek, along with Jeff Christiaansen from Harmony Technologies LLC, have also developed a tool for tracking ethics consults in view of quality improvement (see Health Care Ethics USA, 17, no. 1 [winter2009]: 6-17). An update on this tracking system will appear in the winter 2010 issue of Health Care Ethics USA.

 

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