Ethics consultation in United States hospitals: a national survey.

CONTEXT

Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking.

OBJECTIVE

To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals.

DESIGN

A 56-item phone or questionnaire survey of the "best informant" within each hospital.

PARTICIPANTS

Random sample of 600 U.S. general hospitals, stratified by bed size.

RESULTS

The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices.