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Utilization and Evaluation

John La Puma, MD; Carol B. Stocking, PhD; Marc D. Silverstein, MD; Andrea DiMartini, MD; Mark Siegler, MD

JAMA. 1988;260(6):808-811.

Abstract
A newly established formal ethics consultation service in a university teaching hospital was prospectively evaluated. A physician-ethicist interviewed and examined patients, interviewed family and others as needed, and entered a formal consultation note in the medical record. The requesting physician and the consultant independently completed structured questionnaires. Fifty-one consultation requests were received from 45 physicians from seven departments between July 1,1986, and June 30,1987. Seventeen (33%) of 51 patients were in the intensive care unit, and 19 patients (37%) were fully oriented at the time of consultation. Overall, 61% of the patients survived to leave the hospital. The requesting physician sought assistance with withholding or withdrawing lifesustaining treatment in 49% of cases, with resuscitation issues in 37%, and with legal issues in 31% Assistance with more than one issue was sought in 39 cases (76%). In 36 cases (71%), the requesting physician stated that the consultation was "very important" in patient management, in clarifying ethical issues, or in learning about medical ethics. We conclude that ethics consultation performed by physician-ethicists provides useful, clinically acceptable assistance in a teaching hospital.

(JAMA 1988;260:808-811)

Author Affiliations
From the Section of Clinical Ethics, Lutheran General Hospital, Park Ridge, III (Dr La Puma); and Center for Clinical Medical Ethics and Section of General Internal Medicine, University of Chicago Hospitals and Clinics (Drs La Puma, Stocking, Silverstein, DiMartini, and Siegler).

Footnotes
Presented in part at the Tenth Annual Meeting of the Society for General Internal Medicine, San Diego, May 1,1987.

The views expressed herein are those of the authors and do not necessarily reflect the view of the supporting foundations or institutions.

Reprint requests to Section of Clinical Ethics, Lutheran General Hospital, 1775 Dempster Ave, Park Ridge, IL 60068 (Dr La Puma).

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