HEC Forum

, Volume 28, Issue 3, pp 217–228 | Cite as

What Ethical Issues Really Arise in Practice at an Academic Medical Center? A Quantitative and Qualitative Analysis of Clinical Ethics Consultations from 2008 to 2013

  • Katherine WassonEmail author
  • Emily Anderson
  • Erika Hagstrom
  • Michael McCarthy
  • Kayhan Parsi
  • Mark Kuczewski


As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male (55.8 %), white (57.1 %), between 50 and 69 years old (38.5 %), of non-Hispanic origin (85.9 %), and of Roman Catholic faith (43.6 %). Nearly half (47.4 %) were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making (93.6 %), goals of care/treatment (80.8 %), and end-of-life (73.1 %). More specifically, capacity (57.1 %), patient’s wishes/autonomy (54.5 %), and surrogate decision maker (51.3 %) were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment (12.8 %), patient wishes/autonomy (12.2 %), and capacity (11.5 %). Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field.


Clinical ethics consultation Clinical ethics consultants Quality attestation Retrospective review 


Compliance with Ethical Standards

Conflict of Interest

The authors have no financial conflicts of interest to disclose.


  1. Aulisio, M. P., Chaitin, E., & Arnold, R. M. (2004). Ethics and palliative care consultation in the intensive care unit. Critical Care Clinics, 20(3), 505–523.CrossRefGoogle Scholar
  2. Bruce, C. R., Smith, M. L., Hizlan, S., & Sharp, R. R. (2011). A systematic review of activities at a high-volume ethics consultation service. The Journal of Clinical Ethics, 22(2), 151–164.Google Scholar
  3. Dowdy, M. D., Robertson, C., & Bander, J. A. (1998). A study of proactive ethics consultation for critical and terminally ill patients with extended lengths of stay. Critical Care Medicine, 26(2), 252–259.CrossRefGoogle Scholar
  4. DuVal, G., Sartorius, L., et al. (2001). What triggers requests for ethics consultations? Journal of Medical Ethics, 27(suppl I), i24–i29.CrossRefGoogle Scholar
  5. Fins, J. J., Kodish, E., Braddock, C., Cohn, F., Dubler, N. N., et al. (2013). Quality attestation for clinical ethics consultants: A two-step model from the American Society for Bioethics and Humanities. Hastings Center Report, 43(5), 26–36.CrossRefGoogle Scholar
  6. Forde, R., & Vandvik, I. H. (2005). Clinical ethics, information, and communication: Review of 31 cases from a clinical ethics committee. Journal of Medical Ethics, 31(2), 73–77.CrossRefGoogle Scholar
  7. Forman, J., & Damschroder, L. (2008). Qualitative content analysis. Empirical research for bioethics: A primer (pp. 36–92). Elsevier Publishing: Oxford.Google Scholar
  8. Fox, E., Myers, S., & Pearlman, R. A. (2007). Ethics consultation in United States hospitals: A national survey. The American Journal of Bioethics, 7(2), 13–25.CrossRefGoogle Scholar
  9. Johnson, L. S., Church, C. L., Metzger, M., & Baker, J. N. (2015). Ethics consultation in pediatrics: Long-term experience from a pediatric oncology center. The American Journal of Bioethics, 15(5), 3–17.CrossRefGoogle Scholar
  10. Johnson, L. S., Lesandrini, J., et al. (2012). Use of the medical ethics consultation service in a busy Level I trauma center: Impact on decision-making and patient care. American Surgeon, 78(7), 735–740.Google Scholar
  11. Kesselheim, K. C., Johnson, J., & Joffe, S. (2010). Ethics consultation in children’s hospitals: Results from a survey of pediatric clinical ethicists. Pediatrics, 125(4), 742–746.CrossRefGoogle Scholar
  12. McGee, G., Caplan, A. L., Spanogle, J. P., & Asch, D. A. (2001). A national study of ethics committees. American Journal of Bioethics, 1(4), 60–64.CrossRefGoogle Scholar
  13. McGee, G., Spanogle, J. P., Caplan, A. L., Penny, D., & Asch, D. A. (2002). Successes and failures of hospital ethics committees: A national survey of ethics committee chairs. Cambridge Quarterly of Healthcare Ethics, 11(1), 87–93.CrossRefGoogle Scholar
  14. Moeller, J. R., Albanese, T. H., et al. (2012). Functions and outcomes of a clinical medical ethics committee: A review of 100 consults. HEC Forum, 24(2), 99–114.CrossRefGoogle Scholar
  15. Streuli, J. C., Staubli, G., Pfandler-Poletti, M., et al. (2014). Five-year experience of clinical ethics consultations in a pediatric teaching hospital. European Journal of Pediatrics, 173(5), 629–636.CrossRefGoogle Scholar
  16. Swetz, K. M., Crowley, M. E., et al. (2007). Report of 255 clinical ethics consultations and review of the literature. Mayo Clinical Proceedings, 82(6), 686–691.CrossRefGoogle Scholar
  17. Tapper, E. B., Vercler, C. J., et al. (2010). Ethics consultation at a large urban public teaching hospital. Mayo Clinical Proceedings, 85(5), 433–438.CrossRefGoogle Scholar
  18. Tarzian, A. J. (2009). Credentials for clinical ethics consultation—are we there yet? HEC Forum, 21(3), 241–248.CrossRefGoogle Scholar
  19. Voigt, L. P., Rajendram, P., Shuman, A. G., et al. (2014). Characteristics and outcomes of ethics consultations in an oncologic intensive care unit. Journal of Intensive Care Medicine,. doi: 10.0077/0885066614538389.Google Scholar
  20. Waisel, D. B., Vanscoy, S. E., et al. (2000). Activities of an ethics consultation service in a tertiary military medical center. Military Medicine, 165(7), 528–532.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Katherine Wasson
    • 1
    • 3
    Email author
  • Emily Anderson
    • 1
  • Erika Hagstrom
    • 2
  • Michael McCarthy
    • 1
  • Kayhan Parsi
    • 1
  • Mark Kuczewski
    • 1
  1. 1.The Neiswanger Institute for BioethicsLoyola University Chicago Stritch School of MedicineMaywoodUSA
  2. 2.Loyola University Medical CenterMaywoodUSA
  3. 3.The Neiswanger Institute for BioethicsLoyola University Chicago Stritch School of MedicineMaywoodUSA

Personalised recommendations