Medical ethics decision-making in three hospitals: A look at dilemmas, decision-makers, and the practice of clinical ethics

Abstract

This dissertation is a study of medical ethics decision-making in three American hospitals. It presents the moral issues caregivers and clinical ethicists identify as "struggles", and discusses the process of moral decision-making. The primary data include: (1) detailed interviews (with 49 physicians, nurses, social workers, and clinical ethicists) using open-ended questions; and (2) notes from observations of hospital ethics committee meetings, ethics education sessions, and subject interactions. The study discusses the inherent connection between the law and bioethics, and how medicine, the law, and bioethics can and do conflict. Discoveries emerging from this study include: (1) Caregivers' psychological and physical responses to chronically ill, or otherwise difficult-to-care-for patients influence their decisions regarding treatment--especially to discontinue treatment. (2) Some bioethicists practicing clinically (clinical ethicists) in hospitals do not have the interpersonal skills that the American Society for Bioethics and Humanities (ASBH, 1998) recommends they should have. (3) Open communication regarding death and dying does not usually occur between caregivers and patients/families--even in a cancer hospital. A lack of honest, fruitful discussion during the process of illness exists, often due to the caregivers' discomfort in speaking about death. (4) Ethics Consultants and members of HECs continually state that they give information in an advisory role only. The data collected allow me to argue that declaration is not entirely true, nor should it be.