Background: Little is known about what factors may contribute to the growth of a consultation service or how a practice may change or evolve across time. Methods: This study examines data collected from a busy ethics consultation service over a period of more than two decades. Results: We report a number of longitudinal findings that represent significant growth in the volume of ethics consultation requests from 19 in 1990 to 551 in 2013, as well as important changes in the patient (...) population for which ethics help is requested. The findings include (1) a steady growth in requests from primary care providers (e.g., physicians and nurses), as well as increases in ancillary services (e.g., social workers); (2) a decrease in length of stay (days) before ethics help is requested; (3) an increase in the reasons that individuals ask for help from ethics; (4) an upsurge in consults requests from areas outside the intensive care unit (ICU); (5) a decrease in patients that died during hospitalization (e.g., live discharges); and (6) growth in the numbers of patients lacking decision-making capacity. Conclusions: We believe the increases in consult requests reflect appropriate and necessary growth because recent consultations have also been associated with consultations requiring (7) additional interventions and (8) reasonably high time intensity scores. (shrink)

As the public profile of bioethics rises, and as litigation about issues ranging from assisted reproduction to gene therapy multiplies, the presence of bioethics experts in a litigation context has become more common. Dozens of appellate opinions refer to bioethics testimony in the lower courts. Today's technical advisory services for attorneys advertise bioethics experts along with experts in scientific fields. A single bioethicist has served as an expert in more than fifty cases. In all likelihood, opportunities for bioethicists to fill (...) the role of testifying expert will grow as medicine and biotechnology become more complex. Bioethics experts have also been involved in several other kinds of litigation-related activities, including investigation, consultation with attorneys, preparing reports that express expert opinions, and explaining and defending these opinions by deposition.Despite the growth of these activities by bioethicists, they have never been free of controversy, have recently been received with little enthusiasm by the judiciary, and could become highly problematic in the future. (shrink)

In The Abuse of Casuistry Jonsen and Toulmin describe one view of moral reasoning as follows:Those who take a rhetorical view of moral reasoning… do not assume that moral reasoning relies for its force on single chains of unbreakable deductions which link present cases back to some common starting point. Rather, this strength comes from accumulating many parallel, complementary considerations, which have to do with the current circumstances of the human individuals and communities involved and lend strength to our conclusions, (...) not like links to a chain but like strands to a rope or roots to a tree.Whether or not all moral reasoning resembles “strands to a rope,” bioethics testimony certainly does. Bioethics testimony is eclectic, a composite of many loosely woven strands. Rarely, if ever, is bioethics testimony “a chain of unbreakable deductions.” Rarely is it “pure” ethics, much less pure normative ethics. (shrink)

In The Abuse of Casuistry Jonsen and Toulmin describe one view of moral reasoning as follows:Those who take a rhetorical view of moral reasoning… do not assume that moral reasoning relies for its force on single chains of unbreakable deductions which link present cases back to some common starting point. Rather, this strength comes from accumulating many parallel, complementary considerations, which have to do with the current circumstances of the human individuals and communities involved and lend strength to our conclusions, (...) not like links to a chain but like strands to a rope or roots to a tree.Whether or not all moral reasoning resembles “strands to a rope,” bioethics testimony certainly does. Bioethics testimony is eclectic, a composite of many loosely woven strands. Rarely, if ever, is bioethics testimony “a chain of unbreakable deductions.” Rarely is it “pure” ethics, much less pure normative ethics. (shrink)

In response to a competitive environment, hospital administrators are pressuring physicians to discharge Medicare patients “sicker and quicker” and to transfer indigent patients from their emergency rooms. This paper compares health administrators' ethics to public expectations regarding financially motivated hospital transfers and discharges. Health administrators use balancing strategies: code morality, survivalism, mission dependency, and tithing. Public expectations, exemplified in P.L. 99–272, P.L. 99–509, and recent case law, are based on norms of potential for patient harm and patient occupancy. These norms (...) are morally preferable to those of health administrators; they reinforce the value of identified lives and the reliability of the health care system. (shrink)