SHM Converge Scientific Abstract ePoster Gallery-What Is Your Dilemma? A Thematic Analysis of Ethics Consult Questions From a Hospital Medicine Service

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This study examined 21 ethics consults for patients on a hospital medicine service at a large academic medical center between January 2022 and September 2024. Ethics consultants identified 18 distinct themes across these consults, with all cases involving multiple overlapping issues.<br /><br />The most common themes were:<br />- respect for patient autonomy<br />- conflicts between goals of care and treatment options<br />- disposition issues<br />- proxy-related concerns, including selection of a proxy, how proxies made decisions, and disagreements among proxies<br />- treatment refusal<br />- benefit-versus-burden analysis of treatment options<br /><br />Other recurring themes included decision-making capacity, demands for treatment, and safety concerns. These themes often appeared together in the same consult, reflecting the complexity of ethical decision-making in hospital medicine.<br /><br />The background emphasizes that many ethical issues on hospitalist services are handled informally, and only a small fraction lead to formal ethics consults. However, formal consults are valuable because they highlight the most difficult and nuanced cases. Hospitalists care for acutely ill patients, often under time pressure, with limited opportunity to build trust with patients and families. This helps explain why autonomy, capacity, proxy choice, and treatment refusal are common ethical challenges.<br /><br />The authors conclude that these consults reveal the social and ethical complexity of hospital medicine and the special role of hospitalists in managing such dilemmas. Because the study was limited to a single medical center and did not compare hospital medicine with other specialties, further research is needed. Future work should include qualitative studies of hospitalists’ experiences and help guide education, policy, and quality improvement efforts to better support ethical decision-making in hospital medicine.

Asset Subtitle

Rimma Osipov

Meta Tag

Author List Rimma Osipov

Category Research

Concept Autonomy

Concept Goals of Care

Concept Disposition

Concept Legally Appointed Surrogate

Concept Patient Refusal

Distinguished Non-Finalist

Presenter Organization University of North Carolina Chapel Hill

Presenting Author Rimma Osipov

Track Other

Keywords

ethics consults

hospital medicine

patient autonomy

goals of care

treatment refusal

decision-making capacity

proxy decision-making

disposition issues

benefit-burden analysis

ethical decision-making

Autonomy

Goals of Care

Disposition

Legally Appointed Surrogate

Patient Refusal