Bearing the Burden of Clinical Ethics Consultation: Requests, Roles, and Responses

Abstract: Clinical ethics has continued to evolve in recent decades, prompting extensive discussion about the roles clinical ethicists ought to assume in practice. The desire to cement clinical ethics as a profession has resulted in this role-based discourse centering largely on what clinical ethicists are able to contribute to health care. Significantly less consideration has been given to the emotional impact of assuming such roles, despite the fact that clinical ethicists frequently navigate situations of ethical complexity, conflict, and vulnerability. To better understand the emotional impact that clinical ethics work has on clinical ethicists, we conducted qualitative interviews with thirty-four clinical ethicists between May and September of 2023. Our findings suggest clinical ethicists are assuming a variety of roles in patient care, often shaped by the requests and needs of individuals seeking ethics consultations as well as an underlying desire to be helpful in difficult situations. Thematic analysis revealed four non-mutually exclusive roles based on the type of contribution: supporting, advising, authorizing, and decision-making. The emotional impact described by participants in assuming these roles indicate that clinical ethicists bear some emotional burden regardless of the role they play in patient care. As the field of clinical ethics continues to professionalize, it is essential that the impact of doing the work not be lost in the desire to be helpful. Certainly, the question of how clinical ethicists can help others navigate ethically challenging situations is important. Equally important, though, is the question: what is the cost of doing so?

Monica Gerrek, PhD – Assistant Professor, Department of Bioethics, Case Western Reserve University; Marcie Lambrix, MA, HEC-C – Senior Research Associate, Department of Bioethics, Case Western Reserve University; Marsha Michie, PhD – Associate Professor, Department of Bioethics, Case Western Reserve University