An ethics consultation service in a teaching hospital. Utilization and evaluation
J. La Puma, C. B. Stocking, M. D. Silverstein, A. DiMartini and M. Siegler
Section of Clinical Ethics, Lutheran General Hospital, Park Ridge, IL 60068.
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 life-sustaining
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.
