Care of the Complex Patient in An Uncertain Healthcare System:A Continued Challenge for Clinical Ethics Consultation

Abstract: The focus of hospitals in the United States is largely on acute, episodic events of patients at a time when there is a rise of ‘complex patients’ entering the healthcare system via Emergency Departments. Patients with complex care needs are often admitted to hospitals because of poorly managed chronic comorbid conditions that require advanced medical technology to reverse an acute condition. The result is an ongoing vicious cycle between complex patients’ recurring acute medical conditions and the focus of hospital care on acute events, with the deeper underlying causal problems remaining unaddressed. The current healthcare system is ill-suited to deal with these challenging problems related to factors such as mental illness, substance abuse and nonmedical factors of social determinants of health. In a similar way, clinical ethics consultation services are challenged to provide meaningful application of the principles of medical ethics to these cases. Because so many of the problems of complex patients are deeper structural problems in our communities and society, it is far from clear what it means to respect patient autonomy for patients with diminished chances of achieving their own self-professed life goals, what it means to provide a ‘benefit’, to ‘avoid harm’, or to know what they are ‘due’ based on the principle of justice.
This presentation will focus on the increasingly crucial role of clinical ethics consultation in caring for complex patients by providing sound ethical guidance to healthcare providers in navigating challenging ethical situations and ensuring high-quality, respectful, and patient-centered care is provided.

Keywords: Care of the Complex Patient is an Uncertain Healthcare System., Ethical Considerations in Caring for the Complex Patient