This study was conducted in three surgical intensive care units in National Taiwan University Hospital. Patients with medical uncertainty or conflict regarding value-laden issues, and requests made by the attending physicians or nurses for HCEC from December 1, 2009 to April 30, 2012 were randomly assigned, to the usual care group (UC group) and the intervention group (HCEC group). The patients in the UC group did not receive HCEC, but still received usual care such as family meeting, consultation to social workers and so on, which were considered appropriate by the health care team. The patients in the HCEC group received HCEC conducted by an individual ethics consultant. If a case was assigned to the HCEC group but the attending physician did not want to receive HCEC, the preference of not receiving HCEC was honored. If a case was assigned to the UC group but the attending physician wanted to receive HCEC, the preference of receiving HCEC was honored.
HCEC can be conducted by a hospital ethics committee, a small group of ethics consultants, or an individual ethics consultant [1 ]. In our study, we conducted HCEC by individual ethics consultants. The qualifications, skills and knowledge of an individual ethics consultant have been proposed by Aulisio et al. [20 (link)]. Our individual ethics consultants all have doctoral degrees, received more than a decade of training in clinical medicine, and completed more than 20 hours of clinical ethics educational courses per year. All ethics consultants, while conducting HCEC, were strongly encouraged to follow the suggestions proposed by Aulisio et al. [20 (link)]:
1) Gather relevant data.
2) Clarify relevant concepts.
3) Clarify related normative issues.
4) Help to identify a range of morally acceptable options within the context.
5) Facilitate consensus among involved parties.
HCEC can be conducted by a hospital ethics committee, a small group of ethics consultants, or an individual ethics consultant [1 ]. In our study, we conducted HCEC by individual ethics consultants. The qualifications, skills and knowledge of an individual ethics consultant have been proposed by Aulisio et al. [20 (link)]. Our individual ethics consultants all have doctoral degrees, received more than a decade of training in clinical medicine, and completed more than 20 hours of clinical ethics educational courses per year. All ethics consultants, while conducting HCEC, were strongly encouraged to follow the suggestions proposed by Aulisio et al. [20 (link)]:
1) Gather relevant data.
2) Clarify relevant concepts.
3) Clarify related normative issues.
4) Help to identify a range of morally acceptable options within the context.
5) Facilitate consensus among involved parties.
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