Enriching the Theory and Practice of Trauma Informed Ethics Consultation.

Abstract

We are grateful for the excellent and incisive commentaries on our paper “Trauma Informed Ethics Consultation” (Lanphier and Anani 2022). It is heartening to see most commentators agree with why clinical ethics consultation should be trauma informed, and rightly raise relevant complexities for trauma informed ethics consultation (TIEC) that allow us to clarify and build upon our argument. Many responses introduce questions of how to achieve TIEC as well as how TIEC can support social justice, improved outcomes, and health equity in a variety of settings. Through our research, we recognize that the theoretical objectives of both ethics consultation and trauma informed care (TIC) can be challenging to translate into concrete practice. To some extent, this is due to the idiosyncratic nature of the situations and stories that contribute to both trauma histories, and ethical dilemmas, as well as the diverse responses by individuals and groups to trauma and ethics consultation. Although each ethical dilemma or trauma history is unique, they can align with recognizable patterns requiring a set of core competencies, knowledges, and skills designed to appropriately approach each novel iteration. Thus, we have frameworks like the American Society for Bioethics Core Competencies for Clinical Ethics Consultation (2011), and the Substance Abuse and Mental Health Services Administration’s “Four Rs” and “Six Principles” of TIC (SAMHSA 2014). We draw from these and other frameworks to show not only the complementarity of trauma informed care in ethics consultation, but also its necessity. The next step is translating these frameworks, competencies, or principles into action. In our target article, we began to sketch how TIC could be implemented into ethics consultation using a case in the NICU, but by no means believe that it ought to be limited to neonatal, or even pediatric healthcare. Thankfully, many of our commentators further developed approaches from their specific areas of expertise.