A Deeper Look at Ethics Consultation.

AbstractAutumn Fiester suggests that trauma-informed ethics consultation (TIEC) should focus on surrogate decision makers (SDMs) in preference over patients when (a) the patient is comatose or neurologically devastated, and hence beyond the capacity for suffering or further trauma; (b) the patient is thus incapable of asserting preferences; and (c) the patient's wishes are not known, for example, in the absence of an advance directive. Therefore, (d) in these instances the moral obligation to prevent trauma for SDMs overrides obligations to patients. Perhaps Fiester might countenance other instances, but, as presented, Fiester's TIEC placing others' trauma above patients' is thus construed fairly narrowly. This commentary first offers a few brief observations regarding each tenet of Fiester's argument and then offers broader reflections on ethics consultation and on TIEC in particular. As discussed below, when the issue sparking the request for an ethics consultant (EC) is a bona fide question of values rather than, for example, clearing up miscommunication or identifying a need for further information, ECs aim primarily to gather information and then offer their recommendation(s). This mission, I suggest, stands on thinner ice than we may recognize. Moreover, I will argue that if ECs disclose that mission to patients and SDMs with full clarity and truth, genuine TIEC becomes virtually impossible.