Spielman Bethany, Gorka Christine, Miller Keith, Pointer Carolyn A, Hinze Barbara
Southern Illinois University School of Medicine, Department of Medical Humanities, Springfield, Illinois, USA.
Memorial Medical Center, Clinical Ethics Center, Springfield, Illinois, USA.
J Clin Ethics. 2016 summer;27(2):154-62.
Clinical ethics consultants are expected to "reduce disparities, discrimination, and inequities when providing consultations," but few studies about inequities in ethics consultation exist.1 The objectives of this study were (1) to determine if there were racial or gender differences in the timing of requests for ethics consultations related to limiting treatment, and (2) if such differences were found, to identify factors associated with that difference and the role, if any, of ethics consultants in mitigating them.
The study was a mixed methods retrospective study of consultation summaries and hospital and ethics center data on 56 age-and gender-matched Caucasian and African American Medicare patients who received ethics consultations related to issues around limiting medical treatment in the period 2011 to 2014. The average age of patients was 70.9.
Consultation requests for females were made significantly earlier in their stays in the hospital (6.57 days) than were consultation requests made for males (16.07 days). For African American patients, the differences in admission-to-request intervals for female patients (5.93 days) and male patients (18.64 days) were greater than for Caucasian male and female patients. Differences in the timing of a consultation were not significantly correlated with the presence of an advance directive, the specialty of the attending physician, or the reasons for the consult request. Ethics consultants may have mitigated problems that developed during the lag in request times for African American males by spending more time, on average, on those consultations (316 minutes), especially more time, on average, than on consultations with Caucasian females (195 minutes). Most consultations (40 of 56) did result in movement toward limiting treatment, but no statistically significant differences were found among the groups studied in the movement toward limiting treatment. The average number of days from consult to discharge or death were strongly correlated with the intervals between admission to the hospital and request for an ethics consultation.
Our findings suggest race and gender disparities in the timing of ethics consultations that consultants may have partially mitigated.
临床伦理顾问应“在提供咨询服务时减少差异、歧视和不公平现象”，但关于伦理咨询中不公平现象的研究很少。本研究的目的是：（1）确定在与限制治疗相关的伦理咨询请求时间上是否存在种族或性别差异；（2）如果发现存在此类差异，确定与该差异相关的因素以及伦理顾问在缓解这些差异方面所起的作用（如有）。
本研究是一项混合方法的回顾性研究，对2011年至2014年期间接受与限制医疗问题相关伦理咨询的56名年龄和性别匹配的白种人和非裔美国医疗保险患者的咨询总结以及医院和伦理中心数据进行分析。患者的平均年龄为70.9岁。
女性患者在住院期间提出咨询请求的时间（6.57天）明显早于男性患者（16.07天）。对于非裔美国患者，女性患者（5.93天）和男性患者（18.64天）的入院至请求间隔差异大于白种人男性和女性患者。咨询时间的差异与预先指示的存在、主治医生的专业或咨询请求的原因没有显著相关性。伦理顾问可能通过平均在这些咨询上花费更多时间（316分钟），尤其是平均比与白种人女性的咨询（195分钟）花费更多时间，缓解了非裔美国男性请求时间滞后期间出现的问题。大多数咨询（56例中的40例）确实导致了朝着限制治疗的方向发展，但在朝着限制治疗的进展方面，研究的各组之间没有发现统计学上的显著差异。从咨询到出院或死亡的平均天数与入院至请求伦理咨询的间隔密切相关。
我们的研究结果表明，在伦理咨询时间上存在种族和性别差异，而顾问可能部分缓解了这些差异。
