Keck Hospital of USC & Norris Cancer Center Ethics Resource Committee
Ethics Resource Committee:
Our Ethics Resource Committee (ERC) exists to support our hospital community in three major ways: we provide clinical ethics consultations, develop and revise hospital policies that address ethical issues, and educate care providers and hospital staff about important topics in clinical ethics. Our multidisciplinary committee consists of representatives from medicine, law, nursing, chaplaincy, social work, and the larger Los Angeles community, with the aim of ensuring that we bring a diversity of perspectives to the ethical challenges we encounter.
Clinical Ethics Consultation Service:
A major responsibility of our Ethics Resource Committee is to provide ethics consultations when ethical or moral dilemmas arise – either from the perspective of the medical staff or the patient and family – in the care of patients. Ethical conflicts in patient care can arise when there are conflicts in values or goals of medical treatment between patients, families, and members of the patient’s treatment team. Additionally, the Committee seeks to support staff who experience moral distress in difficult situations.
Through an Ethics Consultation, members of our Ethics Resource Committee speak with all involved parties to gather the relevant medical, psychosocial, spiritual and contextual information to understand the ethical conflict in a particular case. In this process, we seek to clarify the values of all involved parties and to offer recommendations to address the ethical conflict facing the patient and team in a compassionate and supportive way. Ethics consultations are performed by a multidisciplinary subgroup of the Ethics Resource Committee and are led by one of the Ethics Resource Committee Co-Chairs. Our recommendations are communicated verbally to the requesting party and are documented with a note in the patient’s chart. We can continue to assist in the patient’s care for as long as the requesting party would like us to remain involved.
Common Ethical Dilemmas in Medicine
Here are examples of common ethical dilemmas that may arise and warrant the assistance of our committee:
- Medical decision making for patients who are incapacitated and/or have no named medical surrogate decision maker
- Differences of opinion among family members about what a patient would want for him/herself
- Addressing discontinuation of life-sustaining therapies
- Patient refusal of recommended therapies
- Addressing topics that arise in advanced illness and end of life care (resuscitation preferences, goals of care clarification, withholding or discontinuing life-sustaining treatments)
- Differences of opinion between medical staff caring for a patient about what treatment plan is most in line with a patient’s wishes
- Religious or cultural beliefs that may conflict with treatment recommendations
- Moral distress among medical staff
- Difficulties engaging with a surrogate decision maker
When Should an Ethics Consultation Be Requested?
An ethics consultation should be requested whenever there are differences of opinion between members of the treatment team, patient, and/or family about the most ethically sound course of action in the care of a patient. Ideally, consultations should be requested early on in a patient’s hospital stay so that conflicts can be named and addressed in a timely fashion.
Who Can Request an Ethics Consultation?
Students, residents, fellows, nursing staff, social workers, physical/occupational therapists, chaplains, and other members of the hospital staff are all welcome to place an ethics consultation if they confront an ethical conflict in the care of a patient. Additionally, and importantly, patients and family members of patients are also able to place ethics consultations. Unlike other consultations in the hospital, an ethics consultation does not have to be requested or approved by a physician.
How to Request an Ethics Consultation
Please send an email to the Ethics Resource Committee co-chairs to request an ethics consultation. In the email, please detail the name of the patient and their room number; the patient’s diagnosis; a description of the ethical dilemma that has arisen; and your contact information so that we may follow up with you directly and in a timely fashion. You may also call the Medical Staff Office at 323-442-8686 and leave a message with your name, contact information, patient name, and the reason for the ethics consultation request.
What to Expect of an Ethics Consultation
Once you have placed a consultation and spoken with one of our co-chairs, a multidisciplinary team consisting of three members from the Ethics Resource Committee will review the medical record of the patient and begin speaking with the patient, family, and members of the treatment team. After we have gathered all pertinent information and engaged in values clarification with all parties, we will speak with the person or team who requested the consultation and communicate our recommendations. There are times when the most helpful advice we can offer is to make use of one of our hospital policies that may assist in resolving the case. These policies, which are all posted on this page, include the Non-Beneficial Treatment Policy, the Unrepresented Patient Policy, and the DNR policy, among others.
All cases are presented for review at the monthly Ethics Resource Committee meetings, where the subcommittee will elicit the viewpoints and feedback of other committee members. If there are changes to our recommendations after the case is presented to the ERC, we will communicate directly with the requesting person or team about any changes.
Questions? Please feel free to email our Committee Chair:
Sunita Puri, MD (Sunita.firstname.lastname@example.org)