Are We the Best Judges?: Responding When Ethics “Recommendations” Aren’t Followed

Abstract: Clinical ethics has adopted the practice of making “recommendations” in response to at least some consultation requests. While these recommendations are often followed by care providers, there are times when they are not. Most clinical ethics services are “advisory only,” insofar as they never act as medical providers or write medical orders for patients, so it is up to the attending physician or medical team whether to follow ethics recommendations. This panel, made up of two senior clinical ethicists and two clinical ethics fellows, will consider how consultants should respond to situations in which ethics recommendations are not followed. Panelists will discuss cases from their own consultation work where concern about litigation, public perception, unrest, and physical violence resulted in clinical teams acting contrary to ethics’ recommendations. Additionally, we will draw on data analysis from qualitative interviews with 34 clinical ethicists about the emotional impact of their work, centering discussion on reflections about the discomfort, distress, and frustration associated with cases where ethics recommendations were not followed. Panelists will, in turn, consider critical questions regarding the experience of having recommendations rejected, the nature of ethics expertise, the importance of self-reflection in determining appropriate actions when recommendations are not followed, and the potential implications for understanding and addressing barriers to ethical care. Clinical ethicists are not insulated from polarization, threatening discourse, and external pressures in today’s healthcare environment. As a result, it is imperative that those in the field be prepared to respond.

Keywords: Ethics Recommendations, Clinical Ethics