December 27, 2019

The Ever-Expanding Role of Clinical Ethicists

Embedded ethicists do much more than provide insight for medical decision-making

Physician discussion

Margot Eves, JD, MA, serves an important role in patient care at all of Cleveland Clinic’s hospitals in northeast Ohio even though she has no medical degree. She is one of eight clinical ethicists at the Center for Bioethics, which was founded in 1984 to provide ethics consultations, education, policy recommendations and research.

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“Our role is to help when there are conflicts of values among the medical team, patient or family members,” says Eves, Director of the Clinical Ethics Immersion Program in the Center for Bioethics. “We are one resource to help people think through challenging situations, reconcile some of those differences and match the available treatment options with the patient’s values.”

Eves and her colleagues consult on a wide range of topics related to end-of-life issues, medical interventions, informed consent, human research subjects, the role of surrogates and much more. But as the healthcare environment changes rapidly, so too does the job of clinical ethicists.

Three emerging roles of clinical ethicists

Eves co-authored an article in the fall 2019 issue of the Journal of Clinical Ethics on the emerging roles of clinical ethicists, then later explored those roles and how clinical ethicists interface with patients on National Public Radio with her colleague Jane Jankowski, DPS, and other Cleveland-area experts.

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They discussed the following roles:

  • Embedded ethicists – Rather than serving on an ethics committee removed from direct contact with patients, embedded ethicists play a recurring, predictable role in the work of the clinical team. “Being embedded with the healthcare team allows you to learn more about the patient population you serve, as well as understand how the professionals who take care of that population think,” says Eves. “It also gives you a place at the table further upstream to discuss relevant factors that may help avoid some ethical conflicts further down the treatment path.”
  • Ethicists as educators – There has long been a mandate by the American Society for Bioethics and Humanities that ethical consultations include an educational component. “If we educate with every consult, people then develop the tools to address the same type of problems independently next time,” says Eves. But the concept of education is expanding to include the needs of the larger institution. Clinical ethicists may routinely educate multiple disciplines within the healthcare system, from physicians and surgeons to nurses and respiratory therapists. They also may develop continuing education online modules or contribute to curriculum for medical schools associated with their healthcare systems.
  • Ethicists as care providers – “The concept of an ethicist serving as a therapeutic presence is very innovative and not often discussed in our field on a larger scale,” says Eves. “It reflects the moral and emotional distress that happens among healthcare professionals taking care of patients.” When clinical ethicists help patients and healthcare providers make difficult decisions, and those stakeholders subsequently are at peace with those choices, then the ethicists have contributed a therapeutic presence.

“Medicine continues to move toward a team model where everyone contributes to patient care,” says Eves. “With their ever-expanding roles, clinical ethicists are an important part of that team.”

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