The authors work in a variety of clinical ethics consultation services (CECSs) that employ a range of methods and approaches. This article discusses the approach to ethics consultation at the Center for Medical Ethics and Health Policy at Baylor College of Medicine and describes the development and transformation of the authors’ CECSs. It discusses how one CECS shifted from a nascent program with only fifty consultations a year to a vibrant, heavily staffed service with five hundred ethics consultations a year.

Although shared decision-making is a standard in medical care, unilateral decisions through process-based conflict resolution policies have been defended in certain cases. In patients who do not stand to receive proportional clinical benefits, the harms involved in interventions such as cardiopulmonary resuscitation seem to run contrary to the principle of non-maleficence, and provision of such interventions may cause clinicians significant moral distress. However, because the application of these policies involves taking choices out of the domain of shared decision-making, they face (...) important ethical and legal problems, including a recent challenge to their constitutionality. In light of these concerns, we suggest a re-conceptualization of informed non-dissent as an alternative approach in cases where the application of process-based policies is being considered. This clinician-directed communication model still preserves what is valuable in such policies and salvages professional integrity, while minimising ethical and legal challenges. (shrink)

Mitochondrial replacement techniques (MRTs) have made headlines as some countries have passed legislation permitting the creation of “three-parent embryos” and because of the recent revelation that a child has already been born following the use of these techniques. MRTs assist women with severe mitochondrial disease to have children who are free from mitochondrial disease. Essentially, the mitochondrial DNA of an ovum or embryo is removed and replaced with the mtDNA of a donor. The purpose of this paper is to argue (...) that MRTs are ethically impermissible but greater regulation is needed. There are five parts to this paper: (1) a brief history of mitochondrial manipulation, (2) a description of the MRT process, (3) ethical arguments in opposition to MRTs, (4) relevant counterarguments, and (5) a proposal for increased regulation. (shrink)