Community hospital ethics consultation: evaluation and comparison with a university hospital service.

BACKGROUND

Ethics consultants may improve patient care by responding to physician requests for assistance with problems they identify as ethical issues.

OBJECTIVE

To examine three aspects of ethics consultation: the clinical questions asked; the helpfulness of the consultation to requesting physicians; and the differences between consultations performed at a community teaching hospital and those performed at a university hospital.

SETTINGS

A community teaching hospital and a university teaching hospital.

SUBJECTS

Physicians who formally requested ethics consultations in both hospitals and the patients for whom they requested them.

METHODS

Over 2 years (January 1, 1988, to December 31, 1989), we prospectively evaluated a newly established clinical ethics consultation service in a community teaching hospital using confidentially completed, pretested, structured questionnaires, and compared our data with previously reported university hospital data.

RESULTS

During the 2-year study, 104 consultation requests were received from 68 physicians in eight departments. Requesters most often requested consultation about deciding to forego life-sustaining treatment (74%), resolving disagreements (46%), and assessing patient competence (30%). Requesters found the consultation "very helpful" or "helpful" in one or more aspects of patient care in 86% of cases, or in one or more aspects of physician education in 86% of cases. These data are similar to university hospital data.