Characterizing Complexity in Clinical Ethics Consultations

Abstract: As the field of clinical ethics continues to mature and develop quality metrics, defining complexity remains a difficult task. Clinical ethicists often describe complexity as a subjective experience—I know it when I see it—which makes it all the more challenging to measure. However, tracking complexity is crucial as it highlights the institutional value of a consultation service. Currently, we measure complexity by the time spent conducting a consult, but this is an inadequate metric. Time spent on a case does not necessarily reflect its complexity, as it may depend on the consultant's experience or efficiency. To address this issue, we need to shift our focus from the consultant to the case and identify the dimensions of complexity. This paper identifies six dimensions of complexity in clinical ethics consultation: novelty, conflict, vulnerability, intersectional experiences, uncertainty, and coordination. Crucially, these dimensions can be assessed at intake, allowing for early identification of complex consults. This approach will enable us to deepen our understanding of cases and identify trends in consultation data, ultimately promoting case prioritization and effective management of consultant time.