Clarify the ethical question
An ethics consultation helps participants examine uncertainty or disagreement about values and responsibilities in care. The AMA describes its purpose as supporting informed deliberation through clarification, discussion and expertise. It treats consultants as advisers and educators rather than substitute decision makers.
Questions about a patient’s preferences, disagreement over a surrogate’s interpretation or competing concerns about a treatment plan may be suitable reasons to seek the local service. An immediate safety problem also needs the appropriate clinical response; a consult request is not a reason to postpone urgent care.
Make a focused request
Before contacting the service, try to state the dilemma in one sentence. “The team needs help understanding how this decision reflects the patient’s values” gives a clearer starting point than “The family is difficult.” Separate disagreement about facts from disagreement about what ought to be done.
Useful information to prepare includes:
- The decision that needs to be made and its urgency.
- The patient’s expressed goals and preferences.
- Who is participating and what authority they have.
- Relevant clinical information and any important uncertainty.
- Options already discussed and why disagreement remains.
- Communication or access needs for the discussion.
Use approved clinical channels and share information according to the consultation process. Ask who may request a consult, how the patient is informed and how recommendations will appear in the record.
Bring the nursing perspective
In a fictional case, several clinicians describe a patient as consistently requesting one treatment, while the bedside nurse has heard concerns about its effect on daily life. The nurse can contribute the patient’s actual statements and the circumstances of those conversations without claiming to know the patient’s final choice.
The American Association of Critical-Care Nurses recommends access to ethics support and forums for discussing goals of care as part of addressing moral distress. Nursing participation can help the discussion include observations from ongoing care, rather than only information available during a formal meeting.
Agree on what happens afterward
A useful consultation leaves the team able to identify the question examined, the reasoning, the options discussed and any remaining uncertainty. Confirm who will explain the next steps to the patient or surrogate and who is responsible for clinical follow-up.
The AMA guidance emphasizes privacy, appropriate documentation and respect for participation decisions. Follow the local process rather than assuming that every conversation is automatically confidential in the same legal sense or that every recommendation is binding.
If recommendations cannot be followed, ask for the reasons to be made explicit and for unresolved concerns to be addressed. Review surrogate decision making and moral distress for related issues. A consultation supports the decision process; it does not guarantee agreement among everyone involved.
Sources
- AMA Code of Medical Ethics: Ethics Consultations (accessed 2026-09-17).
- AACN: Moral Distress in Times of Crisis (accessed 2026-09-17).