by David Magnus, Ph.D.
This issue of the American Journal of Bioethics contains two extremely important Target Articles in the history of clinical ethics consultation. The first presents the eagerly awaited results of the ASBH attestation pilot, while the second provides a detailed account of the development and application of the VA National Center for Ethics Consultation quality assessment tool that aims to evaluate the quality of an ethics consultation by analysis of documentation.
Together, these articles mark an important step in the development of standards and tools for those of us engaged in clinical ethics consultation. As the authors of both articles and many of the commentaries point out, ethics consultation can literally make a difference of life and death for patients, and it is imperative that we find ways of ensuring quality. At the same time, as also pointed in many commentaries, this is only a first step and many questions remain. Is evaluation of documentation a valid way to assess consultation quality (or only one aspect of consultation)? Are individual consultants (as opposed to whole services) the right unit for assessment? Is there a way of establishing consilience across a range of assessment approaches, thus instilling confidence in the instruments and their application? Can we find high correlations between objective outcomes and assessment tools?
Several lessons can already be gleaned from both the pilot project and the extensive work of the VA National Center in developing the tool. First, it is unlikely that agreement can be achieved across raters for a fine-grained evaluative instrument.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.