Jordan Ellis
Clinical ethicists are experts in ethical issues arising in a clinical context, usually in hospitals. They work in diverse healthcare settings, contributing their expertise to address ethical challenges and promote patient-centred care. Their primary role is to consult with physicians, nurses, hospital staff, patients, and families to identify and address ethical issues. Clinical ethicists also participate in hospital ethics committees, which help clinicians deal with ethical challenges in their clinical practice. They may also be involved in policy development, education and training, and quality improvement programs. Clinical ethicists typically have a master's degree or PhD in a related field and some clinical experience.
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What You'll Learn
Clinical ethicist qualifications and training
Clinical ethicists are professionals in the medical field who focus on maintaining and improving ethical policies and compliance in healthcare facilities. They are required to have a combination of education, training, and practical experience.
Education
Clinical ethicists typically hold a bachelor's degree in a related field, such as philosophy, ethics, law, healthcare administration, or religious studies. While a bachelor's degree in a related field is not always mandatory, it provides a strong foundation for the role.
Aspiring clinical ethicists should then pursue a master's degree or advanced degree in bioethics or a related field. Some universities offer specialised programs in bioethics that provide the in-depth knowledge and skills required for the role. A few clinical ethicists may even pursue a Ph.D. in bioethics or a J.D. specialising in health law.
Training
Clinical ethicists should gain clinical experience through shadowing opportunities or entry-level positions during their graduate or postgraduate studies. They can also pursue a clinical residency or fellowship in bioethics or clinical ethics, which provides hands-on experience and mentorship under experienced clinical ethicists.
Certifications
Certifications can enhance credentials and demonstrate a commitment to professional standards. Here are some certifications that clinical ethicists may consider:
- Certified Healthcare Ethics Consultant (CHEC): Offered by the American Society for Bioethics and Humanities (ASBH) for individuals providing ethics consultation in healthcare settings.
- Certified Clinical Ethicist (CCE): Offered by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), requiring the passing of an examination and meeting specific educational and experiential requirements.
- Healthcare Ethics Consultant-Certified (HEC-C): Provided by the Healthcare Information and Management Systems Society (HIMSS).
- Certified IRB Professional (CIP): Geared towards individuals involved in the ethical review of research involving human subjects, demonstrating expertise in research ethics and oversight.
- Certified Hospice and Palliative Care Administrator (CHPCA): While not specific to ethics, this certification is relevant for clinical ethicists specialising in end-of-life care.
Additional Experience
Attorneys specialising in health law may also pursue positions as clinical ethicists. Furthermore, paid postdoctoral programs offer clinical training and research time, serving as great stepping stones to full-time positions.
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Ethical consultations
Clinical ethicists are responsible for conducting ethical consultations with healthcare teams, patients, and their families to address challenging ethical issues that arise in medical care. They provide guidance and help navigate complex ethical dilemmas, ensuring patient-centred care. Ethical consultations can involve a range of topics, and ethicists may offer different types of support.
Firstly, clinical ethicists often engage in direct consultations with healthcare teams, patients, and families. They may be consulted on specific ethical dilemmas, such as treatment decisions, end-of-life care, organ transplantation, or other moral quandaries. Ethicists work closely with healthcare professionals, including physicians, nurses, and social workers, to address these issues. They gather information, speak with involved parties, and provide recommendations to help resolve ethical concerns.
Secondly, clinical ethicists may also offer legal and policy advice to hospital committees, senior leadership, and advisory boards. They ensure that policies and procedures adhere to ethical standards and provide guidance on upcoming initiatives or procedure changes. Ethicists contribute to the development and implementation of ethical policies, collaborating with healthcare institutions to align practices with legal and ethical norms.
Thirdly, clinical ethicists can provide mediation services, helping to resolve conflicts between patients, families, and medical staff. They facilitate compromise and support patients in making informed decisions about their medical care, even when it may not be supported by healthcare experts or insurance companies. Ethicists ensure that patients' rights are protected and respected.
Additionally, clinical ethicists are involved in education and training within healthcare institutions. They offer sessions for healthcare professionals, staff, and students on ethical principles, values, and best practices. Ethicists promote ethical awareness and understanding among healthcare providers, fostering a culture of ethical decision-making.
Lastly, clinical ethicists may also specialise in specific areas, such as research ethics, paediatric ethics, or end-of-life care ethics. For example, research ethics specialists focus on overseeing the ethical conduct of medical research, assessing protocols, and safeguarding participants' rights. Paediatric ethics specialists address ethical issues related to decision-making for children and adolescents, navigating the unique challenges in this area. End-of-life care ethicists guide difficult decisions around withdrawing or withholding treatment, advance care planning, and palliative care.
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Policy development
Clinical ethicists play a vital role in healthcare institutions, specialising in the ethical dimensions of healthcare and medical decision-making. They address ethical challenges and promote patient-centred care by assisting healthcare providers, patients, and families in navigating complex ethical issues that may arise in the course of medical care.
Clinical ethicists contribute to policy development by collaborating with healthcare institutions to develop, review, and implement ethical policies and guidelines. They ensure that protocols are created in alignment with legal and ethical standards, fostering consistent and ethical care practices. This involves offering guidance to institutional ethics committees on policy formulation, as well as participating in hospital ethics committees that serve as forums for interdisciplinary collaboration. These committees bring together healthcare professionals, legal experts, and ethicists to navigate ethical dilemmas and develop policies that address complex ethical issues.
Clinical ethicists also contribute to quality improvement programs within hospitals, working to change aspects of how the hospital functions to align with ethical standards. For example, when medical assistance in dying was legalised in Canada, clinical ethicists played a role in developing processes to ethically enact the legislation. During the COVID-19 pandemic, clinical ethicists were involved in policy-level work, ensuring ethical considerations in decision-making.
In addition to policy development, clinical ethicists provide ethical consultations, education, and training within healthcare institutions. They offer guidance to patients, their families, and healthcare professionals on ethical, legal, and policy issues arising from clinical interactions. Clinical ethicists may also specialise in specific areas, such as research ethics, paediatric ethics, or end-of-life care ethics, further contributing to the development and implementation of ethical policies and practices in these areas.
Clinical ethicists typically hold advanced degrees in ethics, philosophy, or related fields, and have clinical experience. They must possess strong analytical skills, the ability to communicate complex ethical concepts effectively, and a nuanced understanding of ethical principles to navigate the practical challenges in healthcare settings.
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End-of-life care
In the context of end-of-life care, the central philosophical question is how to make decisions about treatments to administer, taper off, cease, or withhold. Traditionally, ethicists have prioritised the patient's wishes, but some argue that other interests, such as the wishes of family members, should also be considered. For example, in the case of paediatric patients, decisions are made in accordance with ethical principles and the laws of the relevant country. While children under 18 are not legally considered competent to make these decisions, their preferences should still be taken into account, and they should be informed about their end-of-life care.
Physicians also face ethical challenges when it comes to palliative care and the use of opioids and sedatives. While these drugs provide effective relief from pain and distressing symptoms, there is a misconception that increasing doses may shorten the patient's life. The doctrine of double effect (DDE) justifies this consequence, but it also raises concerns about dangerous practices. Clinicians must balance their role as advisors with respect for the patient's right to consent or refuse treatment, and they may need to explore the reasons behind a patient's refusal of certain treatments.
To improve end-of-life care, hospitals should have clear policies and procedures to guide clinicians' decisions, especially when patients lack decision-making capacity or healthcare proxies. Central repositories should be established to efficiently obtain documents such as advance directives and proxy identifications. Additionally, healthcare facilities should honour orders on the Doctor's Order Sheet to respect patient wishes regarding avoidable treatments.
In conclusion, end-of-life care requires careful ethical consideration and respect for patient autonomy. Clinical ethicists play a crucial role in navigating these complex decisions and ensuring that the patient's best interests are at the heart of their care.
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Hospital ethics committees
Clinical ethicists are specialists in the ethical dimensions of healthcare and medical decision-making. They work in hospitals and other healthcare institutions, addressing ethical challenges and promoting patient-centred care. They are typically trained in ethics, philosophy, or a related field, and bring a nuanced understanding of ethical principles to practical challenges in healthcare. Clinical ethicists may also be known as ethics consultants, research ethics specialists, or end-of-life care ethicists, depending on their specific role and focus.
Clinical ethicists are often members of hospital ethics committees, where they actively participate in discussions and consultations related to ethical dilemmas in patient care. These committees are interdisciplinary forums that bring together healthcare professionals, legal experts, and ethicists to provide guidance on complex cases and policy development. The committees facilitate sound decision-making that respects the values, concerns, and interests of all involved.
The role of a clinical ethicist in a hospital ethics committee includes conducting ethical consultations with healthcare teams, patients, and families to provide guidance on challenging ethical issues. This may involve discussions related to treatment decisions, end-of-life care, organ transplantation, and other moral dilemmas. Clinical ethicists also contribute to policy development, collaborating with healthcare institutions to develop, review, and implement ethical policies and guidelines. They ensure that ethical considerations are integrated into protocols and that consistent and ethical care practices are followed.
In addition, clinical ethicists may offer legal and policy advice to hospital advisory committees and senior leadership. They evaluate the patient-physician relationship and determine if the patient is capable of making sound decisions. Clinical ethicists also review genetic testing and research experiments to ensure ethical conduct and safeguard the rights and well-being of participants. They provide education and training to healthcare professionals, staff, and students on ethical principles and best practices. Furthermore, clinical ethicists may participate in quality improvement programs to effect systemic change in the hospital or health system.
The work of hospital ethics committees and clinical ethicists is crucial in navigating the complex ethical landscape of healthcare. By providing guidance, consultations, and education, they ensure that patient care is centred on ethical principles and respect for patient autonomy. Clinical ethicists contribute to policy development and systemic improvements, promoting ethical practices throughout the healthcare institution.
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Frequently asked questions
A hospital ethicist is a doctor or medical professional who provides guidance on ethical, legal, and policy issues that arise in healthcare settings. They address ethical challenges and promote patient-centred care.
Hospital ethicists offer consultations to healthcare teams, patients, and families to help them navigate complex ethical issues. They also contribute to policy development, serve on ethics committees, and provide education and training on ethical principles.
Hospital ethicists may provide guidance on a range of ethical issues, including treatment decisions, end-of-life care, organ transplantation, do-not-resuscitate orders, and medical research ethics. They also address ethical challenges arising from new technologies in healthcare.
Hospital ethicists typically work in hospitals, healthcare systems, academic medical centres, and other healthcare institutions. They may also work in medical schools or universities to pursue specialised studies or teach ethical principles.
Hospital ethicists typically have a master's degree or a doctorate in a field related to health or medical ethics. They also have clinical experience and may have completed a residency program with a focus on ethical issues. Some positions may require additional years of experience and certifications.
