The evolving role of a 'clinical ethicist'. Issue 1 (1st June 2011)

• Record Type: Journal Article
• Authors: Detering, K; Silvester, W
• Is Part Of: BMJ supportive & palliative care. Volume 1:Issue 1(2011)
• Page Start: 80
• Page End: 80
• Publication Date: 2011-06-01
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2011-000053.49
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Background: Austin health is a 600 bed tertiary hospital with a wide range of acute and sub acute services, including a number of specialist services. Many patients have extremely complex medical and ethical issues that are often raised during the care of these people. In order to address such concerns a 'clinical ethicist', who is an experienced doctor has been employed. Aim: To perform a retrospective audit of consecutive cases referred to the clinical ethicist. Results: 104 patients, mean age 66 (range 19–102), 64% male were seen. ▶ Reason for referral - (≥1 reason per patient). ▶ Unrealistic patient/family (34%). ▶ Poor or unrealistic medical assessment of situation (53%). ▶ Patient/family in need of advance care planning (44%). ▶ Outcome of referral – treatment related (≥ 1 per patient). ▶ Patient died or discharged (63%). ▶ Decision to limit treatment (64%). ▶ Advance care planning occurred (45%). ▶ Treating doctors ignored recommendation of clinical ethicist (5%). ▶ Outcome of referral – people related (≥1 per patient). ▶ Staff Education (71%). ▶ Improved staff morale (31%). ▶ Support of medical decision making (41%). ▶ Patient/family support (42%). Patient deaths were, on average 70 days (range 1–619) from initial referral. Conclusion: Establishment of the clinical ethicist role has provided support and education to staff and patients. Although not specifically set up to focus on end-of-life decision making and care, the majority of patients seen have died. This role also has an important link in referring patients/families for advance care planning.