An “ethics consult” is a service, which can be requested by a patient, family member or member of the medical team to discuss conflicts of values, uncertainty about what is the “right” thing to do, and issues like whether to stop life support.

Many patients don’t know that ethics consults even exist, much less that they are free (the hospital picks up the tab). But ethics consultation services are available in 81 percent of all US hospitals – and all US hospitals with more than 400 beds, according to a survey published this year by Dr. Ellen Fox of the Department of Veterans Affairs and her colleagues. Ethics experts typically are doctors, nurses, chaplains or other medical professionals with extra training in ethics.

You should ask for an ethics consult for decisions such as when to end life support, or whenever you feel uncertainty about the right thing to do or, with an incapacitated patient, whenever it’s not clear who the decision maker should be, said Barbara L. Chanko and Kenneth A. Berkowitz, ethicists from the VA who recently gave a workshop at Harvard Medical School.

You can also call in an ethicist if someone, a medical provider or family member, is domineering and not listening to others’ views. “Think of an ethics consult as dispute resolution. The time to go to an ethics consult is when things get heated. And if the word ‘lawsuit’ is crossing your mind, talk to the ethics committee,” said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.

Doctors and nurses often ask for an ethics consult when a patient refuses a treatment with seemingly obvious benefit, for instance, a patient with a gangrenous leg who rejects amputation. An ethics consult can clarify whether a patient is refusing because of lack of information about the seriousness of the disease or because the person prefers to die “whole.”

Basically, said Dr. Lachlan Forrow, director of ethics programs at Beth Israel Deaconess Medical Center, “If you aren’t sure something is an ethics issue, it’s an ethics issue.” By Judy Foreman http://www.boston.com/news/science/articles/2007/12/31/what_is_an_ethics_consult_and_when_should_patients_get_it/