The clinical ethics consultation (CEC): clarification tool for physicians and patients to avoid complaints?

Title: The clinical ethics consultation (CEC): clarification tool for physicians and patients to avoid complaints? Authors: R. Minacori*, D. Sacchini*, N. Comoretto°, and A.G. Spagnolo* Institutions: * Institute of Bioethics “A. Gemelli” School of Medicine, Università Cattolica del Sacro Cuore (UCSC) – Rome; °Athenaeum Centre for Bioethics - Rome Campus (UCSC) Learning Objectives A better understanding of how CEC can reduce the risk of complaints Background The CEC aims to help patients, their families, caregivers and healthcare professionals to cope with ethical issues arising in patient care. Less attention has been paid to the impact of CEC on patients/family-doctors relationship and the risk of complaints. A better understanding of how CEC influences this factor might identify opportunities for reduce this risk. Aim We examined the role of CEC as tool for improving the quality of patients/family-doctors relationship and to avoid patients complaints. Methods We examined 93 CECs conducted at “A. Gemelli” Academic Hospital (January 1994-October 2010), requested from different clinical departments, especially for end-of-life decision making issues with or without mentally incompetent patients. Conflict or fear of conflict by doctors existed. The CEC focused on a wide range of ethical concerns, but also social and medico-legal issues trying to identify key elements that might impact on the patients/family-doctors relationship and could determine disagreement. Results The reasons for dissatisfaction of patients/family seems related not only to physicians’ technical skills but also to relationship issues. We observed that relationship difficulties could complicate other issues. The follow-up seems indicate that no complaints has subsequently developed from these cases, some of which are particularly sensitive. Conclusion In our experience, the CEC provided a help to analyze from the ethical point of view the most problematic aspects of clinical situations and the possible solutions for decision making. The CEC also facilitated the physician/patient/family interaction, clarifying the objectives of care for patient’s best interest and encouraging decisions sharing.