Making visible the invisible elements of clinical ethics consultation

By Clare Delany, Sharon Feldman, Barbara Kameniar, and Lynn Gillam.

In our article, ‘Making clinical ethics facilitation visible and accessible: Seven steps of the Critical Dialogue method of Ethics Consultation’, we detail our method of clinical ethics facilitation, broken down into seven steps. We also share the rationale for the various steps, and provide concrete examples for how they might be implemented, including suggested scripting in some places.

The Children’s Bioethics Centre (CBC) at the Royal Children’s Hospital in Melbourne, Australia, was formally established in 2008. Our service supports clinicians and families facing ethical challenges including high stakes decisions, diverging views, conflict and moral distress regarding treatment and decisions about treatment for children.

In responding to and leading ethics consultations, we recognise the importance of a robust and transparent process. Although there are published models and styles of clinical ethics consultation approaches discussed in the clinical ethics literature, the detailed processes of thinking and clinical ethics ‘know how’ of a clinical ethicist during a consultation can be’ invisible’ (and therefore largely inaccessible) to others.

In our clinical ethics service, we have consistently reflected on the goals of ethics consultations and processes of facilitation employed by the ethicist. In these reflections we have sought to unpack and make visible, the reasoning behind the facilitating ethicist’s decisions: to speak, to listen, to guide, to raise ethics concepts, to summarise, to advise, to stay quiet and wait.

Following clinical ethics consultations with individual clinicians or with clinical teams or with families, our reflective questions have included: What strategies of facilitation did the ethicist use? How did people engage with the ethics discussion? What was the original ethical question framed in the consultation referral and what was the core ethical concern discussed in the meeting? What other ethical concerns emerged through the discussion? Which ethics concepts and theories were introduced by the ethicists? Were there other frameworks or normative concepts that could have been used to shed light on and clarify ethical questions?

These reflections led us, over time, to formulate and importantly to articulate, the goals and processes of ethics facilitation within consultations. We have been able to detail how the processes of ethics facilitation led to the identification of a principled resolution to an ethical challenge. We were able to ‘see’ how the discussion shifted clinicians’ understanding and appreciation of ethical dimensions of their work.

Our paper contributes to the scholarship of clinical ethics methods by making the “invisibles” of clinical ethics consultation visible.


Paper: Critical dialogue method of ethics consultation: making clinical ethics facilitation visible and accessible

Authors: Clare Delany, Sharon Feldman, Barbara Kameniar, and Lynn Gillam

Competing interests: None declared

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