A recent Ethics Column discussed decision-making capacity (DMC) in everyday treatment decisions. In this column, we discuss how members of the Kennedy Krieger Institute Ethics Program approach ethical challenges.
As part of our ethics consultation process, we use the CASES approach as suggested by the National Center for Ethics in Health Care. The CASES approach involves five steps:
C—Clarify the request and obtain preliminary information about the challenge
A—Assemble the relevant information from each source identified
S—Synthesize the information to determine whether a formal meeting is required
E—Explain the synthesis by communicating all information to the key participants
S—Support the consultation process by following up with the key participants
When a patient, family member or staff member approaches the Ethics Program with an ethical concern or challenge, we strive to provide a clear description of the ethics consultation process and how it helps resolve ethical issues. This includes information regarding the goals of ethics consultation, the expected time frame for completing the consultation, and the specific actions we will take, which ultimately consist of recommendations, not directives. We usually communicate this information both orally and in a summary report.
Sometimes people have misconceptions about the role of the Ethics Program. Some of these common misconceptions are that we:
- Investigate an allegation of serious abuse
- Rubber stamp what the health care team wants or what the patient or family wants
- Clean up a “mess” within a department
- Inform the requester about what is legal (or not legal)
- Tell the requester what to do
- Take the decision out of the hands of the family or staff member
- Never report anything to authorities
- Tell someone he or she is being unethical
- Influence the patient, doctor, nurse or family to see things the requester’s way
Instead, we offer an opportunity to analyze important ethical challenges in an open way and offer ethically permissible actions for the requester to consider.