J Clin Ethics. 2019 Fall;30(3):251-261.

Clarifying a Clinical Ethics Service's Value, the Visible and the Hidden.

Guidry-Grimes L¹, Warren M², Lipman HI³, Kent K⁴, Krishnamurthy KB⁵, Davis AM⁶, May T⁷, Jiro MC⁸, Jankowski J⁹.

Author information

1

Assistant Professor of Medical Humanities and Bioethics at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, and Affiliate Faculty at the Center for Health Literacy in Little Rock, Arkansas USA. LGuidrygrimes@uams.edu.

2

Network Ethicist at Nova Scotia Health Ethics Network and an Assistant Professor in the Dalhousie University Department of Bioethics in Dalhousie, Nova Scotia, Canada.

3

Director of Bioethics at Hackensack University Medical Center and Associate Professor of Medicine at Hackensack Meridian School of Medicine at Seton Hall in Hackensack, New Jersey USA. Hannah.Lipman@Hackensack Meridian.org.

4

Cleveland Fellow in Advanced Bioethics at the Cleveland Clinic in Cleveland, Ohio USA. kentk@ccf.org.

5

Assistant Professor in Neurology at Harvard Medical School in Boston, Massachusetts, and Chair of the Ethics Committee at St. Elizabeth's Medical Center in Brighton, Massachusetts USA. Kaarkuzhali_Krishnamurthy@hms.harvard.edu.

6

Director of the Clinical Ethics Service at UNC Hospitals, and Associate Professor of Social Medicine at the UNC School of Medicine in Chapel Hill, North Carolina USA. arlene_davis@med.unc.edu.

7

Floyd and Judy Rogers Endowed Professor at the Elson S. Floyd College of Medicine, Washington State University, in Spokane, Washington USA. thomas.may@wsu.edu.

8

Bioethics Research Associate in the Northern California Regional Ethics Program, Kaiser Permanente. marycon.c.jiro@kp.org.

9

Associate Staff Bioethicist at the Center for Bioethics at the Cleveland Clinic in Cleveland, Ohio USA. jankowj@ccf.org.

Abstract

Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un-Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic.