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Mandatory Ethics Consultation Policy


      To describe ethics consultations at a single institution that has a mandatory ethics consultation policy.


      We retrospectively reviewed the medical records of all adult patients who were admitted to the intensive care unit at Columbia University Medical Center and had an ethics consultation between August 1, 2006, and July 31, 2007. All mandatory and nonmandatory ethics consultations were reviewed. Patient diagnosis, prognosis, presence of do-not-resuscitate order, presence of written advance directives, reason for the ethics consultation, and survival data were collected. The number of ethics consultations hospital-wide from January 1, 2000, to December 31, 2007, was collected.


      The total number of mandatory and nonmandatory ethics consultations requested was 168. Of these consultations, 108 (64%) were considered mandatory, and 60 (36%) were considered nonmandatory. Between January 1, 2000, and December 31, 2007, the total number of ethics consultations increased 84%.


      The increase in the total number of ethics consultations is interpreted as a positive outcome of the mandatory policy. The mandatory ethics consultation policy has possibly increased exposure to ethics consultant-physician interactions, increased learning for physicians, and raised awareness among physicians and nurses of potential ethics assistance.
      CUMC (Columbia University Medical Center), DNR (do-not-resuscitate), ICU (intensive care unit)
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        • Duff RS
        Guidelines for deciding care of critically ill or dying patients.
        Pediatrics. 1979; 64: 17-23
        • Danis M
        • Feuerman D
        • Fins JJ
        • et al.
        Incorporating palliative care into critical care education: principles, challenges, and opportunities.
        Crit Care Med. 1999; 27: 2005-2013
        • Gavrin JR
        Ethical considerations at the end of life in the intensive care unit.
        Crit Care Med. 2007; 35: S85-S94
        • Rubenfeld GD
        • Randall Curtis J
        • End-of-Life Care in the ICU Working Group
        End-of-life care in the intensive care unit: a research agenda.
        Crit Care Med. 2001; 29: 2001-2006
        • Carlet J
        • Thijs LG
        • Antonelli M
        • et al.
        Challenges in end-of-life care in the ICU: statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003.
        Intensive Care Med. 2004; 30: 770-784
      1. In the Matter of Westchester County Medical Center on Behalf of Mary O'Connor, Appellant. Helen A. Hall et al., Respondents. 72 N.Y.2d517, 531 N.E.2 507, 534 N.Y.S.2d 886 (N. Y. 1988;[Oct]:14). Accessed April 23, 2009.

        • Swetz KM
        • Crowley ME
        • Hook C
        • Mueller PS
        Report of 255 clinical ethics consultations and review of the literature.
        Mayo Clin Proc. 2007; 82: 686-691
        • La Puma J
        Consultations in clinical ethics-issues and questions in 27 cases.
        West J Med. 1987; 146: 633-637
        • La Puma J
        • Stocking CB
        • Silverstein MD
        • DiMartini A
        • Siegler M
        An ethics consultation service in a teaching hospital: utilization and evaluation.
        JAMA. 1988; 260: 808-811
        • Andereck WS
        Development of a hospital ethics committee: lessons from five years of case consultations.
        Camb Q Healthc Ethics. 1992 Winter; 1: 41-50
        • Orr RD
        • Moon E
        Effectiveness of an ethics consultation service.
        J Fam Pract. 1993; 36: 49-53
        • Schenkenberg T
        Salt Lake City VA Medical Center's first 150 ethics committee case consultations: what we have learned (so far).
        HEC Forum. 1997; 9: 147-158
        • Waisel DB
        • Vanscoy SE
        • Tice LH
        • Bulger KL
        • Schmelz JO
        • Perucca PJ
        Activities of an ethics consultation service in a tertiary military medical center.
        Mil Med. 2000; 165: 528-532
        • Forde R
        • Vandvik IH
        Clinical ethics, information, and communication: review of 31 cases from a clinical ethics committee.
        J Med Ethics. 2005; 31: 73-77
        • La Puma J
        • Stocking CB
        • Darling CM
        • Siegler M
        Community hospital ethics consultation: evaluation and comparison with a university hospital service.
        Am J Med. 1992; 92: 346-351
        • DuVal G
        • Clarridge B
        • Gensler G
        • Danis M
        A national survey of U.S. internists' experiences with ethical dilemmas and ethics consultation.
        J Gen Intern Med. 2004; 19: 251-258
        • Fox E
        • Myers S
        • Pearlman RA
        Ethics consultation in United States hospitals: a national survey.
        Am J Bioeth. 2007; 7: 13-25
        • Christakis NA
        • Asch DA
        Biases in how physicians choose to withdraw life-support.
        Lancet. 1993; 342: 642-646
        • Schneiderman LJ
        • Gilmer T
        • Teetzel H
        • et al.
        Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial.
        JAMA. 2003; 290: 1166-1172
        • Brennan TA
        Ethics committees and decisions to limit care: the experience at the Massachusetts General Hospital.
        JAMA. 1988; 260: 803-807
        • Schneiderman LJ
        • Gilmer T
        • Teetzel HD
        Impact of ethics consultations in the intensive care setting: a randomized, controlled trial.
        Crit Care Med. 2000; 28: 3920-3924