What is a clinical ethicist?

Published: Thursday, April 18, 2024
Hellen Ransom, DHCE, HEC-C
Clinical Ethicist

When you think about employees at a hospital, physicians, nurses, technicians, pharmacists, and other clinicians probably come to mind. But there are many other essential members of the team at Northeast Georgia Health System (NGHS), including a clinical ethicist.

You probably know what most of those roles above do—a physician makes diagnoses and offers treatment, while a pharmacist fills prescriptions, for example. What is the role of a clinical ethicist?

While less familiar than other members of the hospital team, a clinical ethicist has some important responsibilities. Keep reading for the details.

What does a clinical ethicist do?

To understand the role of a clinical ethicist, it’s important to first understand what ethics are. Merriam-Webster defines ethics as “a set of moral principles, or a theory or system of moral values.” Other definitions include “a guiding philosophy” and “principles of conduct governing an individual or a group.”

Ethics play a key role in society—and they’ve long played a role in medicine. Have you ever heard of the Hippocratic oath? This oath is used even today in the graduation ceremonies at many medical schools, but its origins date back to ancient Greece. A Greek physician named Hippocrates created a code of ethics to guide the conduct of medical providers.

Part of the original oath says, “Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from any voluntary act of mischief and corruption.” That portion of the oath has transitioned to today’s familiar “first do no harm.”

Physicians and advanced care practitioners, including physician assistants and nurse practitioners, are guided by an ethical code. Their mission is to provide care that benefits the patient, that avoids or limits harm, and that respects the values and preferences of the patient.

On occasion, though, the preferences of the patient (and their family) may not be aligned with goals of medical providers. That’s where a clinical ethicist steps in.

A clinical ethicist has three primary responsibilities:

  • Clinical ethics consultation, providing support related to ethical issues and questions that arise in the healthcare setting
  • Education, offering formal and informal education around topics related to ethics and the consultation process
  • Policy review, providing reviews and suggested changes to policies to follow updated ethical guidelines

In each of those roles, the ethicist may be providing resources and support for a patient, a clinician, or both.

What ethics are involved in medicine?

The “first do no harm” principle in the Hippocratic oath goes a long way toward understanding ethics in medicine. Every action that medical providers take is guided by some basic principles, or ethics.

A 2021 article in Medical Principles and Practice identified four ethical principles that guide health care:

  • Autonomy
  • Beneficence
  • Justice
  • Nonmaleficence

Autonomy is the principle that respects the ability of competent patients to hold views, make choices, and take actions based on their personal values and beliefs. This principle is seen in medicine today in the forms of informed consent, truth-telling, and confidentiality.

You’ve probably seen all three of these practices in action. Before medical procedures and other treatments, you are required to provide informed consent that you understand what’s happening and agree to the treatment.

Your medical providers adhere to truth-telling when they provide you with factual information about your health, a medical condition, or treatment options. Confidentiality today is codified by law under HIPAA, the Health Insurance Portability and Accountability Act, which forbids sharing a patient’s confidential medical information.

Beneficence is the principle that medical providers have an obligation to act on behalf of their patients. There can be various affirmative ways to support this principle; preventing harms from happening to patients, removing harms that are happening to patients, and bringing about good for patients.

Justice is the principle of providing fair, equitable, and appropriate treatment to all people. Inclusion of justice as one of the basic principles highlights the complexities of distributing medical resources fairly and consistently.

Nonmaleficence is the principle that medical providers have an obligation not to harm patients. This is the ethic referenced in the Hippocratic oath from ancient Greece and in the commonly referenced maxim of “first do no harm.”

While there are other ethics guiding medical care today, such as the need to provide a harassment-free environment, these are the basics that have guided medicine for centuries.

What types of things does a clinical ethicist do during an average day?

A lot of things! The day of a clinical ethicist is filled with variety.

At NGHS, the clinical ethicist is responsible for supporting five different campuses, attending rounds at each campus. “Rounds” are the sessions that physicians, residents, and other providers have at the bedside of the patient, recapping the patient’s medical issue and next steps.

The clinical ethicist attends rounds in order to support and provide consultation when needed. This involves providing perspective and guidance when requested by a clinician or a patient but also listening and watching to be sure the patient understands what’s happening and can make decisions.

The average day also includes time spent responding to requests for consults. Consults may be requested for many reasons, but the most common relate to DNR (do not resuscitate) requests and the need to determine a surrogate decision-maker for a patient without the capacity to take in medical information and make decisions.

Along with these two tasks, a clinical ethicist’s day may also include committee meetings, along with educational initiatives such as book clubs or ethics huddles.

Why is the role of a clinical ethicist important in medicine today?

It’s pretty interesting to think about, actually. Clinical ethicists have become more prevalent in the past half century or so. In fact, according to a 2023 article in the journal Social Science and Medicine, 86 percent of hospitals today have some kind of ethics consultation.

There are a few reasons for that, but one key reason is a change in the structure of physician-patient relationships. In the past, medicine traditionally followed a paternalistic care model, where a health care provider made decisions for a patient.

Since the 1960s, medicine has gradually trended toward a patient-centered care model, meaning that the patient’s needs and wants are considered foremost. Under this type of care model, patients and their families take medical providers’ recommendations under advisement but have the right to consent or refuse medical treatment.

At times, the patient’s wants may conflict with the recommendations of a physician or another medical provider, which is when a mediator—the clinical ethicist—steps in to help. An ethicist serves as an unbiased third party who can help patients, their families, and providers walk through the situation.

There are a couple other reasons why clinical ethicists play an important role in medical care today—the increasing roles of medical technologies and laws impacting health care.

Like ethics in any other part of life, there are many different confusing and complex aspects of ethics in medicine. A clinical ethicist steps in to provide clarity and help with understanding other perspectives.

More than anything, an ethicist serves as a go-between to connect medical providers and patients when there’s a conflict of any kind. That can be a significant conflict, such as a disagreement over a treatment plan, or an issue where more effective communication solves the problem.

No matter what the issue, a clinical ethicist is there to support both clinicians and patients, providing a helping hand to guide medical care.