Ethics consultations are touted for resolving ethical dilemmas, and
most hospitals use them to meet the Joint Commission for the Accreditation
of Healthcare Organizations' requirement for a process to resolve conflicts
in patient care.1 Little rigorous evidence
is available, however, about the outcomes of ethics consultations.2,3 In this issue of THE JOURNAL, Schneiderman
and colleagues4 report a multisite randomized
controlled trial to evaluate ethics consultations. The intervention, which
builds on a previous single-center randomized trial,5 involved
ethics consultation in the intensive care unit (ICU) for conflicts and value
disagreements either among the health care team or between the team and patients
or surrogates. The comparison group received standard care, in which 25% of
those patients chose ethics consultation. Schneiderman et al found that patients
in the intervention group who died spent 3 fewer days in the hospital, 1.4
fewer days in the ICU, and 1.7 fewer days receiving mechanical ventilation
than nonsurvivors in the control group. Almost 90% of surrogates and physicians
agreed or strongly agreed that the ethics consultation was helpful. The authors
concluded that ethics consultations reduced nonbeneficial care without increasing
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