The ASBH Clinical Ethics Consultation Affairs (CECA) standing committee requests your assistance in evaluating the finalized Code of Ethics for Health Care Ethics (HCE) consultants. This survey should take about 10-15 minutes to complete. Please note that the Code Preface and Responsibility Statements have already undergone extensive revision based on prior survey feedback and CECA member review. We ask that you indicate your willingness to endorse the Code elements here, understanding that a code of ethics is an evolving document. Please complete this survey only once. Responses are anonymous unless you include identifying information in comments. We appreciate your feedback!

This Survey is organized by presenting specific elements of the proposed Code of Ethics for Health Care Ethics Consultants (including the preface) followed by a question asking about the degree to which you agree or disagree with the statement “I endorse this portion of the Code.” The Survey includes eight (8) questions.
Element 1. Preface to the Code of Professional Responsibilities for Health Care Ethics Consultants.

This statement sets out the core ethical responsibilities of anyone engaged in health care ethics (HCE) consultation.

HCE consultation is “a set of services provided by an individual or group in response to questions from patients, families, surrogates, health care professionals, or other involved parties who seek to resolve uncertainty or conflict regarding value-laden concerns that emerge in health care” (ASBH, 2011). The goals of HCE consultation include identifying, clarifying and analyzing the ethical issues that underlie the consultation. Ethics consultation seeks to facilitate agreement among involved parties about ethically justifiable options. It addresses the ethical concerns of persons involved in health care decision making and medical research, including patients, families, and providers, and those who set guidelines and create policies.

In addition to their role as HCE consultants, some individuals are also members of other professions and may be accountable to different codes of ethics. While engaging in ethics consultation, individuals should adhere to the Code of Ethics for HCE consultants.

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* 1. Check the box below to indicate the degree to which you agree or disagree with the statement, “I endorse this portion of the Code.”

Element 2. Be Competent. HCE consultants should practice in a manner consistent with professional HCEC standards.

HCE consultants should have the knowledge, skills, and abilities necessary to effectively fulfill their roles in HCEC. The core competencies for performing HCE consultations are evolving. A current resource is the American Society for Bioethics and Humanities' "Core Competencies for Health Care Ethics Consultation" (2011). Competency requires education and training to initially achieve and subsequently maintain the knowledge, skills, and abilities required to do HCEC effectively.

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* 2. Check the box below to indicate the degree to which you agree or disagree with the statement, “I endorse this portion of the Code.”

Element 3. Preserve integrity. HCE consultants should consistently act with integrity in the performance of their HCEC role.

HCE consultants should strive to be worthy of the trust placed in them by patients, staff and the institutions who seek their help in addressing ethical questions and problems. Integrity involves acting in a manner that is consistent with one’s core beliefs and values. Integrity in an HCE consultant involves commitment to the core values underlying HCEC. This requires an ongoing commitment to cultivating habits of excellence, such as self-awareness and open-mindedness.

Consultants should strive to safeguard the process of moral deliberation in the institutions where they provide ethics consultation. They should foster learning and model collegiality in the ethically complex, emotionally tense, high-stakes situations they often face. Integrity dictates that HCE consultants elicit and respect the various perspectives of involved parties. Consultants should preserve professional integrity by not engaging in activities that involve giving an ethical justification or stamp of approval to unethical practices. When in the course of performing HCEC, if a conflict involving the consultant’s personal core beliefs or values arises, the consultant should resolve the conflict in such a way that the consultant maintains his/her personal and professional integrity. (See also Code Responsibility #3)

HCE consultants promote integrity when they provide transparent services and subject their work to peer review and quality improvement.

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* 3. Check the box below to indicate the degree to which you agree or disagree with the statement, “I endorse this portion of the Code.”

Element 4. Manage conflicts of interest and obligation. HCE consultants should anticipate and identify conflicts of interest and obligation and manage them appropriately.

Conflicts of interest involve situations in which the professional judgment of a HCE consultant is, or may appear to be, affected or compromised by competing interests such as personal or financial interests. For example, consultants employed by an institution may be reluctant to disagree with someone of authority and influence within the institution. This demonstrates competing interests in preserving one’s employment and competently performing consultation. Conflicts of obligation involve situations in which HCE consultants’ work is or may appear to be affected or compromised by competing professional and/or personal responsibilities. For example, a consultant who is also a social worker or director of an intensive care unit may experience pressure as part of that role to limit a patient’s length of stay, which may not be in the patient’s best interests. Personal and professional obligations may also be in conflict, when, for example, one has a duty to keep other work-related or personal commitments and a competing duty to complete an ethics consultation in a timely manner.

HCE consultants should appropriately manage conflicts of interest or obligation. Principle strategies include avoidance, recusal, and disclosure. An Ethics Consultation Service with multiple consultants can, for example, assign cases with attention to avoiding conflicts. When this is not possible, consultants may recuse themselves from the consultation, or disclose the conflict. For example, many HCE consultants who are employed or paid by the facility where the ethics consultation request occurs disclose this potential conflict of interest to patients or family members at the onset of a case consultation. Consultants should make efforts to negotiate terms of service that minimize the occurrence of conflicts of interest and obligation and allow them to be managed appropriately.

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* 4. Check the box below to indicate the degree to which you agree or disagree with the statement, “I endorse this portion of the Code.”

Element 5. Maintain confidentiality. HCE consultants should protect private information obtained during HCEC, handling such information in accordance with standards of ethics, law, and organizational policy.

Confidentiality is the duty to respect others’ control over their private information.

In the consultation process, HCE consultants are entrusted with private information about patients, families, providers, and institutions. Maintaining confidentiality is a high priority. Consultants are subject to laws, such as HIPAA, and institutional policies regarding the handling of private information.

There are, however, times when HCE consultants should divulge confidential information. When it is necessary to provide significant benefit, e.g., protect life or prevent serious harms, consultants may be obliged to share relevant private information with others, including health care providers, agents appointed in an advance directive, child/adult protective services agencies and/or law enforcement personnel. The information should only be communicated to those who need to know and only the minimum amount of information necessary should be shared. When appropriate, HCE consultants should prospectively communicate the limits of confidentiality protection.

Information obtained during HCEC may legitimately be used for a variety of other purposes, including peer review, quality improvement, education, and scholarship. Management strategies for maintaining confidentiality vary among these purposes. For example, one may seek to maintain confidentiality by removing identifiers, using pseudonyms, and/or altering inconsequential information. In some situations, written informed consent should be obtained from those whose private information would be disclosed.

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* 5. Check the box below to indicate the degree to which you agree or disagree with the statement, “I endorse this portion of the Code.”

Element 6. Contribute to the field. HCE consultants should participate in the advancement of HCEC.

Each HCE consultant shares in the professional commitment to advance the quality and effectiveness of HCEC. Consultants should contribute to the field by maintaining their competency and engaging in HCEC quality improvement at the institutions they serve. Contributions may also include, for example, engaging in research, publishing, mentoring, teaching, community outreach, case review, and participating in professional organizations. These contributions may be local, regional, national, or international in scope.

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* 6. Check the box below to indicate the degree to which you agree or disagree with the statement, “I endorse this portion of the Code.”

Element 7. Communicate Responsibly. When communicating in the public arena (including social media), HCE consultants should clarify whether they are acting in their HCEC role, and should communicate in a professionally responsible manner.

Communicating responsibly obliges HCE consultants to be sufficiently informed about issues on which they communicate publicly, including an understanding of facts and scholarship relating to the topic. If HCE consultants do not have sufficient knowledge in a particular area, they should decline to comment and consider referring to others. Public comments should acknowledge uncertainty about norms or lack of consensus where it exists. Consultants should recognize that the topics upon which they are asked to comment can generate strong reactions. Communicating responsibly should promote reflection in others and an opportunity to deliberate different points of views. HCE consultants should demonstrate cultural humility and sensitivity to differing values when communicating about HCEC-related issues in the public arena.

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* 7. Check the box below to indicate the degree to which you agree or disagree with the statement, “I endorse this portion of the Code.”

Element 8. Promote just health care within HCEC. HCE consultants should work with other health care professionals to reduce disparities, discrimination and inequities when providing ethics consultation.

Disparities, discrimination and inequities in health care are well-documented. When doing ethics consultation, the consultant needs to be attentive to the role these issues may play in the course of HCEC. Consultants should ensure that all stakeholders have access to the HCEC process, and that the process is fair. Issues of power, majority, and organizational culture may make the process of ethics consultations more challenging, which may in turn complicate efforts to promote just and equitable recommendations and outcomes. Consultants should strive to include marginalized voices in the discourse. Conclusions or recommendations of the consultation should not reinforce injustice. Consultants should identify systemic issues constraining fair outcomes in HCEC and bring these issues to the attention of individuals or groups in a position to address them.

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* 8. Check the box below to indicate the degree to which you agree or disagree with the statement, “I endorse this portion of the Code.”

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* 9. Final Comments (Optional)

THANK YOU for your feedback! Check the ASBH website for further developments.

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