Introduction to ASBH’s Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants For presenters: The content in the Notes view.

Introduction to ASBH’s Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants For presenters: The content in the Notes view of the slides is provided so that presenters can understand the frame of reference used by Clinical Ethics Consultation Affairs (CECA) Committee members in creating the slide presentation. Audience members should have a copy of the Code of Ethics available for reference during the slide presentation. The presenter should be familiar with (and ideally have a copy of) Core Competencies for Healthcare Ethics Consultation (American Society for Bioethics and Humanities [ASBH], 2011). The answers given for the study questions in the section “Applying the Code of Ethics” represent the best answers, not necessarily the only correct answers. Recommended reading: Carrese, J. A., & Members of the American Society for Bioethics and Humanities Clinical Ethics Consultation Affairs Committee. (2012). HCEC pearls and pitfalls: Suggested do’s and don’t’s for healthcare ethics consultants. Journal of Clinical Ethics, 23 (3), 234240. Tarzian, A. J., Wocial, L. D., & the American Society for Bioethics and Humanities Clinical Ethics Consultation Affairs Committee. (2015). A code of ethics for health care ethics consultants: Journey to the present and implications for the field. American Journal of Bioethics, 15(5), 3851. doi: /

Introduction The material in this presentation was developed by members of the Clinical Ethics Consultation Affairs (CECA) Committee of the American Society for Bioethics and Humanities (ASBH) to introduce ASBH’s Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants (the Code of Ethics or the Code) to those engaged in ethics-related work. Special recognition goes to Courtenay Bruce for her efforts in developing this presentation. The CECA Committee advises the ASBH Board of Directors on issues, products, and initiatives related to healthcare ethics (HCE) and healthcare ethics consultation (HCEC). The ASBH board approved the final version of the Code of Ethics in January 2014.

Objectives Describe the process used to develop the Code of Ethics.
Discuss key elements of the Code of Ethics. Identify opportunities and strategies for using the Code of Ethics.

Intended Audience Students and trainees in healthcare ethics consultation (for learning about the responsibilities involved in ethics consultation) New and seasoned ethics committee members who are new to ethics consultation (for self-study and for use in mentoring) Experienced practitioners in ethics consultation (for self-assessment) The Code is intended for individuals who perform healthcare ethics consultation, for committees who oversee this work, and for those studying bioethics.

Definitions Healthcare Ethics Consultation
A set of services provided by an individual or group in response to questions from patients, families, surrogates, healthcare professionals, or other involved parties who seek to resolve uncertainty or conflict regarding value- laden concerns that emerge in health care ASBH’s Core Competencies for Healthcare Ethics Consultation (2011) ASBH’s Core Competencies for Healthcare Ethics Consultation (2011) contains a consensus on the nature and goals of healthcare ethics consultation and the skills, knowledge, and character traits required for performing such consultation. This first code of ethics focuses on individuals who provide HCEC in clinical settings. We say “first” because we expect that the 2014 version of the Code will be amended over time.

Definitions Healthcare Ethics Consultant
A professional in a healthcare setting who seeks to identify and support the appropriate decision maker(s) in a given situation involving ethical questions and to promote ethically sound decision making by facilitating communication among key stakeholders, fostering understanding, clarifying and analyzing ethical issues, and including justifications when recommendations are provided ASBH’s Core Competencies for Healthcare Ethics Consultation (2011) Other services an HCE consultant may provide include developing and managing an ethics program at a healthcare organization, providing organizational ethics leadership (including identifying ethical issues that may arise in the organization), revising and developing policies, educating staff and community members outside of HCEC, conducting and disseminating research, and providing professional development (Chidwick et al., 2010). Chidwick, P. I., Bell, J., Connolly, E., Coughlin, M. D., Frolic, A., Hardingham, L.,…Canadian Bioethics Society Taskforce on Working Conditions for Bioethics. (2010). Exploring a model role description for ethicists. HEC Forum, 22(1), 31–40.

Development of the Code of Ethics

Why Was a Code of Ethics Needed?
To establish boundaries for professional practice To provide guidance to practitioners To further the professionalization of the HCE consultant’s role Rationales and examples Establishing boundaries: The authority of ethics consultants, coupled with the vulnerability of others in healthcare settings, creates the potential for abuse of power. Example: A hospital social worker who is also an HCE consultant is asked to respond to an HCEC request involving a patient who lacks decision-making capacity. The social worker should clarify the scope of her role as an HCE consultant and be clear about the role in which she is performing. Providing guidance: Healthcare practitioners who face challenging situations often need guidance. Example: An HCE consultant has a background in law and was a medical malpractice lawyer before becoming an HCE consultant. The requester of an HCEC asks the ethics consultant about liability risks in a case involving a potential medical error. The consultant for an ethics consultation should not offer legal advice or analyses. Furthering professionalization: Professionals should have shared values and be able to describe how commitments are to be upheld. Example: HCE consultants should participate in regular educational offerings to enhance their skills, abilities, and competence as HCE consultants.

Brief History ASBH’s Advisory Committee on Ethics Standards (ACES) conducts a needs assessment regarding a code of ethics. (2005) ACES issues a summary report; 61% of respondents support development of a code of ethics. ASBH announces its support for the professionalization of HCE consultants. (2009) The CECA Committee drafts a code and solicits feedback from the ASBH membership. (2009–2013) In 2005, Robert Baker proposed a draft code of ethics for bioethicists, which elicited several commentaries from peers in the American Journal of Bioethics. Commentators generally agreed that a code needs to be a living document, an axis around which the profession can evolve, and that the process used to create such a document ought to be transparent and inclusive. In the same year, the ASBH Board of Directors appointed an Advisory Committee on Ethics Standards (ACES) to conduct a needs assessment survey regarding a code of ethics. ACES members concluded with a recommendation that the ASBH board “initiate a process of drafting and promulgating a comprehensive Code of Ethics that will be owned by its membership” (Baker, Pearlman, Taylor, & Kipnis, 2006, p. 29). In 2009, the ASBH board formed the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee charged with drafting a code of ethics for this subset of bioethicists: HCE consultants who do ethics consultation in clinical settings (sometimes referred to as clinical ethics consultants). The CECA Committee decided to use a blended approach, using the empirical data already collected (albeit with a broader focus on bioethics and humanities) and the following precursor documents to inform the first draft of the new code: The ACES report (Baker et al., 2006) The first and second editions of ASBH’s Core Competencies for Healthcare Ethics Consultation (respectively, Society for Health and Human Values–Society for Bioethics Consultation Task Force on Standards for Ethics Consultation, 1998; American Society for Bioethics and Humanities Core Competencies Update Task Force, 2011) Model Code of Ethics for Bioethics [draft] (MacDonald, n.d.). References American Society for Bioethics and Humanities. Core Competencies Update Task Force. (2011). Core competencies for healthcare ethics consultation (2nd ed.). Glenview, IL: Author. Baker, R. A. (2005). A draft model aggregated code of ethics for bioethicists. American Journal of Bioethics, 5(5), 33–41. Baker, R., Pearlman, R., Taylor, H., & Kipnis, K. (2006). Report and recommendations of the American Society for Bioethics and Humanities’ Advisory Committee on Ethics Standards. Glenview, IL: American Society for Bioethics and Humanities. Retrieved from MacDonald, C. (n.d.). Model code of ethics for bioethics [Draft]. Retrieved from Society for Health and Human Values–Society for Bioethics Consultation Task Force on Standards for Ethics Consultation. (1998). Core competencies for health care ethics consultation. Glenview, IL: American Society for Bioethics and Humanities.

Development Process Initial elements of the Code drafted
Input from practitioners sought through survey Survey responses analyzed by CECA subgroups. Findings reflected broad support for initial draft. Feedback led to revisions of content and language. Efforts made to build consensus Final revisions made Approval given by ASBH board Details of the process Version 1 of the Code was shared broadly (not just with ASBH members) by electronic survey; survey responses were overwhelmingly positive (2011). The CECA Committee made revisions. Version 2 was presented at the 2012 ASBH annual meeting, and further revisions were made. A second survey solicited feedback on the revised version (2013). Using survey results, CECA revised and refined the language. The CECA Committee presented a revised draft to the ASBH board and at the 2013 ASBH annual meeting. The ASBH board approved the Code of Ethics in January 2014.

Sample Comments Content
Clarify the document’s scope and target audience. Clarify the relationship between ASBH’s Code and other professional codes. Language Clarify the language to make it understandable to those affected by ethics consultation. Clarify the language taken from ASBH’s core competencies.

Preface and Responsibility Statements
The Code consists of (1) a preface professing the commitment to shared values and (2) seven responsibility statements spelling out how the commitments are to be carried out.

Preface Purpose “The statements in this code set out the core ethical responsibilities of individuals performing healthcare ethics consultation (HCEC).” Scope “The content largely but not exclusively addresses patient-focused consultative activities, often referred to as clinical ethics consultation.” ASBH’s Code of Ethics (2014, p. 1) The Code does not focus explicitly on the ethical obligations entailed in the range of additional (nonconsultative) ethics services that HCE consultants may provide for an organization.

1. Be Competent Competence requires
receiving continuing education and experiential training meeting standards that have achieved fieldwide acceptance, including those in ASBH’s Core Competencies for Healthcare Ethics Consultation (2011).

2. Preserve Integrity Preserving integrity involves
making a commitment to HCEC core values and cultivating attributes, attitudes, and behaviors that enable one to perform HCEC well fostering learning and facilitating respectful interactions during moral deliberation refraining from giving a stamp of approval to practices believed to be inconsistent with ethical standards recusing oneself when a conflict involving the consultant’s core beliefs or values arises in a case.

3. Manage Conflicts of Interest and Obligation
Conflicts of interest: situations in which the professional judgment of an HCE consultant is or may appear to be affected or compromised by competing interests such as personal, professional, or financial interests Conflicts of obligation: situations in which the HCE consultant’s work is or may appear to be affected or compromised by competing professional or personal responsibilities In the first draft of the Code, the content of this responsibility statement appeared in two separate statements: Managing conflicts of interest involves handling competing interests of preserving employment and competently performing consultation. Managing conflicts of obligation involves minimizing the likelihood that conflicts will interfere with the consultants’ duties toward those who seek their advice and support through HCEC negotiating terms of service that minimize the occurrence of conflicts of interest and obligation and allow them to be managed appropriately adhering to the Code of Ethics while engaging in ethics consultation.

4. Respect Privacy and Maintain Confidentiality
Respecting privacy and maintaining confidentiality involves honoring others’ right to control access to their private information, including information entrusted to the HCE consultant discreetly sharing the minimum amount of information necessary when divulging confidential information is necessary to provide significant benefit (protecting life or preventing serious harms).

5. Contribute to the Field
Advancing the field of HCEC involves fostering the collective good of the profession and the constituencies it serves publishing, mentoring, teaching, conducting community outreach, conducting or participating in research, and participating in professional organizations. Contributions to the field can be made in local, regional, national, or international arenas. They may be made in one or more domains, and they need not entail academic publication.

6. Communicate Responsibly
Responsible communication involves being informed about issues on which one comments in the public arena declining to comment (or referring a question to others) when one lacks sufficient knowledge on an issue acknowledging uncertainty about norms and lack of consensus where they exist demonstrating cultural humility and sensitivity to different values. The demonstration of cultural humility promotes reflection in others and involves consideration of different points of view (see the discussion of cultural humility in Tervalon and Murray-Garcia [1998]). Reference Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125.

7. Promote Just Health Care
The promotion of just health care in HCEC involves being attentive to the possible role of healthcare disparities, discrimination, and inequities in HCEC ensuring that all stakeholders have access to HCEC ensuring that the HCEC process is fair identifying and including relevant voices in HCEC identifying systemic issues that may influence fair outcomes in HCEC and responding appropriately. This responsibility establishes the HCE consultant’s obligation to address justice at the level of the individual HCEC. Although HCE consultants are not obligated by this Code to work toward rectifying broader issues of societal injustice, the Code supports and encourages such activities.

What the Code of Ethics Does
formalizes efforts to professionalize HCE consultants professes a commitment to shared values and responsibilities establishes an aspirational tone outlines some key ethical issues in the field. The Code of Ethics first professes a commitment to shared values by those working in HCEC and then spells out how the profession’s distinctive commitments are to be carried out. The framers of the Code strove to achieve an aspirational tone, using “should” language, not “must” language. This decision was made partly out of a recognition of the current lack of mechanisms for enforcing the Code.

What the Code of Ethics Does Not Do
discuss or endorse other aspects of professionalization codify the knowledge and skill that consultants should possess address how the code is enforced discuss evaluation criteria.

Applying the Code of Ethics
The study questions and case studies in this presentation may be used for both self-study and teaching. Note: The answers given in the explanations for the study questions represent the best answers, not necessarily the only correct answers. A Resource for Ethics Consultation Services, Bioethics Teachers, and Ethics Committees

Study Question 1 An ethics consultant is eating lunch in the cafeteria with two nurses and a social worker. The ethics consultant and the social worker had recently participated in a family meeting involving a patient with suicidal ideation. The two nurses are not involved in the patient’s care. The ethics consultant and the social worker begin talking about the patient and what occurred in the family meeting, including specific details about sensitive information. Their conversation can be overheard by the nurses at their table and by others in the cafeteria. This is a violation of the responsibility statement dealing with which area? A. Managing conflicts of interest B. Respecting privacy and maintaining confidentiality C. Promoting just health care D. Contributing to the field The presenter should allow the audience time to consider the answers before clicking to the next slide, which contains the best answer, along with an explanation.

Study Question 1 An ethics consultant is eating lunch in the cafeteria with two nurses and a social worker. The ethics consultant and the social worker had recently participated in a family meeting involving a patient with suicidal ideation. The two nurses are not involved in the patient’s care. The ethics consultant and the social worker begin talking about the patient and what occurred in the family meeting, including specific details about sensitive information. Their conversation can be overheard by the nurses at their table and by others in the cafeteria. This is a violation of the responsibility statement dealing with which area? A. Managing conflicts of interest B. Respecting privacy and maintaining confidentiality C. Promoting just health care D. Contributing to the field

Study Question 1: Explanation
The best answer is B. The HCE consultant is entrusted with private information, and privacy and confidentiality should be respected. In this case, the social worker and the ethics consultant are talking in a location where the likelihood of being overheard by others is high. The risk of breach of confidential information is high, and the risk of harm could be high, especially because the case involves particularly sensitive information. Confidential information should be shared only in limited circumstances when necessary to provide significant benefit (e.g., to protect life or prevent serious harms). Even in these rare circumstances, only the minimum amount of information necessary should be shared discreetly. Answer B is the best answer because the ethics consultant is discussing a case in a public setting in which the potential for a violation of confidentiality is quite large. Answers A, C, and D are not relevant in this case.

Study Question 2 In an on-line forum called “The Bioethics Blurb,” an ethics consultant writes a commentary about Jehovah's Witnesses who refuse blood transfusions. In her commentary, she writes that “it is ethically inappropriate to allow patients to make foolish decisions. Blood products should be given, even against patients’ wishes.” This is a violation of the responsibility statement dealing with which area? A. Managing conflicts of obligation B. Respecting privacy and confidentiality C. Preserving integrity D. Communicating responsibly

Study Question 2 In an on-line forum called “The Bioethics Blurb,” an ethics consultant writes a commentary about Jehovah's Witnesses who refuse blood transfusions. In her commentary, she writes that “it is ethically inappropriate to allow patients to make foolish decisions. Blood products should be given, even against patients’ wishes.” This is a violation of the responsibility statement dealing with which area? A. Managing conflicts of obligation B. Respecting privacy and confidentiality C. Preserving integrity D. Communicating responsibly Answer A, managing conflicts of obligation, is not relevant. Although answer B, respecting privacy and confidentiality, may be relevant, it does not represent the biggest error. Regarding answer C, preserving integrity, the comments do reflect a lack of respect for the values of others, but the violation of integrity occurred through a mistake in communication.

The best answer is D. Communicating responsibly requires that HCE consultants be sufficiently informed about the issues on which they communicate in the public arena. Public comments should acknowledge uncertainty about norms and lack of consensus where they exist. The ethics consultant’s statement is problematic for at least two reasons: The comment runs counter to ethical consensus about a patient’s right to refuse treatment, but the consultant does not indicate that her position is outside the scope of consensus. The comment demonstrates an insensitivity to values different from the consultant’s own. It is worth noting that public comments may appear in peer-reviewed published work, but anything posted online (e.g., on a social media site, via Twitter, or in a personal blog) is considered a public statement, and if the statement can be attributed to an HCE consultant, the comments reflect on HCE consultants as a whole.

Study Question 3 A physician requests assistance from the HCE consultant regarding goals of care for a patient with end-stage pancreatic cancer. The patient is willing and able to participate in decision making. The HCE consultant recommends a family meeting with the patient’s surrogate decision maker, the attending physician, the nurse, and the social worker. The HCE consultant conducts the meeting in a conference room outside the patient’s room. The patient is not present and is not asked whether she wishes to participate.

Study Question 3 (continued)
This is a violation of the responsibility statements dealing with which areas? Being competent; promoting just health care within HCEC Respecting privacy and confidentiality; managing conflicts of interest and obligation Contributing to the field; managing conflicts of interest and obligation Communicating responsibly; respecting privacy and confidentiality

This is a violation of the responsibility statements dealing with which areas? Being competent; promoting just health care within HCEC Respecting privacy and confidentiality; managing conflicts of interest and obligation Contributing to the field; managing conflicts of interest and obligation Communicating responsibly; respecting privacy and confidentiality In this scenario, the HCE consultant failed to address the patient’s capacity and include the patient in the activities necessary to complete the HCEC.

The best answer is A. HCE consultants should meet standards of competence that have achieved fieldwide acceptance, including those in ASBH’s Core Competencies for Healthcare Ethics Consultation (2011). In the interest of serving justice in HCEC, consultants have a responsibility to identify and include relevant voices in the discourse. To successfully respond to request for an ethics consultation, the consultant must be able to identify which individuals need to be involved. A patient with decision-making capacity should be asked to participate in a meeting involving the patient’s treatment plan. This scenario violates two of the core competencies for HCEC: Process Skill 1, “Establish HCEC expectations and determine whom to involve,” and Interpersonal Skill 4, “Represent the views of the involved parties to others” (ASBH, 2011, p. 25).

Study Question 4 An ethics committee is consulted on a case involving a 32-year-old woman who is 12 weeks pregnant with her third child and is suffering from pulmonary hypertension. Her physicians believe she is at imminent risk of dying if the pregnancy continues. The ethics committee is asked to provide an ethics analysis addressing the question of whether the pregnancy can be terminated to protect the patient’s health and life. The chair of the ethics committee is morally opposed to abortion for any reason. Decisions about termination of pregnancy are obvious examples of cases where a consultant’s personal beliefs may present a conflict. Other examples would be cases involving a decision to withdraw life-sustaining treatment or to aid a patient in dying (in states where such aid is legal).

The committee chair should Try to put aside personal feelings during the consultative process. Disclose to the patient’s husband that he is morally opposed to abortion and allow the patient’s husband to decide whether and how the chair should be involved. Recuse himself from chairing the committee for this consultation after identifying another committee member who is willing and able to lead the committee meeting. Ask a chaplain what he should do and follow the chaplain’s advice.

The committee chair should Try to put aside personal feelings during the consultative process. Disclose to the patient’s husband that he is morally opposed to abortion and allow the patient’s husband to decide whether and how the chair should be involved. Recuse himself from chairing the committee for this consultation after identifying another committee member who is willing and able to lead the committee meeting. Ask a chaplain what he should do and follow the chaplain’s advice. Answer C best recognizes the significance of the committee chairperson’s obligation to adhere to the responsibility statements in the Code.

The best answer is C. If a conflict involving the consultant’s personal beliefs or values arises in the course of performing HCEC, the consultant should recuse himself or herself from the case after securing the services of a replacement. If no replacement is available, the primary obligation of the HCE consultant is to maintain professional integrity. This obligation is discussed in more detail under the second responsibility statement in the Code of Ethics, “Preserve integrity.” Answer A, putting aside personal feelings, is not helpful. Answer B, turning the matter of the chairperson’s involvement over to the patient’s husband, puts the husband in a difficult position unnecessarily and may send the message that the pregnancy termination is not an ethical choice. Answer D, consulting a chaplain, may help the committee chair personally, but a chaplain may not be familiar with the HCEC Code of Ethics and therefore unable to advise the chair on his obligations as a HCE consultant.

Study Question 5 A hospital administrator recognizes that the HCEC service has been effective in resolving ethical disputes and addressing ethical concerns. She believes that the service can be used to meet hospital goals in reducing length of stay. She approaches the director of the HCEC service, who is also an attending physician in the intensive care unit, and asks the director to “focus on length of stay and on moving patients out of the hospital regardless of the measures necessary.”

What action(s) taken by the director of the HCEC service would be considered appropriate under the Code of Ethics? (Check all that apply.) The director should disclose the administrator’s request to her supervisor. The director could explain why focusing on length of stay may not be in the patient’s best interest. The director could explain the nature and purpose of ethics consultations and explain that the administrator’s request does not align with HCE consultants’ professional obligations.

What action(s) taken by the director of the HCEC service would be considered appropriate under the Code of Ethics? (Check all that apply.) The director should disclose the administrator’s request to her supervisor. The director could explain why focusing on length of stay may not be in the patient’s best interest. The director could explain the nature and purpose of ethics consultations and explain that the administrator’s request does not align with HCE consultants’ professional obligations. Answer A is not particularly helpful. The action is not inappropriate; however, it does not pertain to any of the responsibilities outlined in the Code.

The best answers are B and C. It is not unethical to consider length of stay if it relates to the patient’s best interest, but this factor as it relates to the hospital’s bottom line should not be the driving force behind the ethics analysis or recommendation. Conflicts of obligation involve situations in which HCE consultants’ work is or may appear to be affected or compromised by competing professional or personal responsibilities. The conflicting obligation here is between the HCE consultant’s two roles: director of the HCEC service and attending physician in the ICU. HCE consultants should minimize the likelihood that conflicts will interfere with their duties toward those who seek their advice and support through HCEC. This example also demonstrates the need for preserving professional integrity in separating conflicting roles of HCE consultants. Principal strategies include avoidance, recusal, and disclosure. Consultants should make efforts to negotiate terms of service that minimize the occurrence of conflicts of interest and obligation and allow them to be managed appropriately.

Case Study 1 An HCE consultant on call for the HCEC service has to pick up her 6-year-old son from school. Just as she is leaving the hospital, she receives a page requesting a consultation. The requester, a resident physician, asks how decisions should be made for a patient that lacks decision-making capacity and has no family members (i.e., is unrepresented). Because the HCE consultant has to leave to pick up her son, she quickly cites the relevant state statute, which says that the medical team can make treatment decisions on behalf of a patient who lacks capacity and is unrepresented, in accordance with the patient’s wishes (if known) or, secondarily, the patient’s best interest.

Case Study 1 (continued)
Citing the grounds of the patient’s best interest, the resident physician withdrew life-sustaining treatment after this advice was given, and the patient died. Had the HCE consultant looked at the medical record or talked to the attending physician or the social worker, she would have learned that the patient had several family members, all of whom were willing and able to make treatment decisions in accordance with the patient’s wishes (which would have supported continued aggressive measures). Exercise: Which, if any, of the responsibilities in the Code were violated?

Case Study 1: Discussion
This case involves issues of competence and conflicts of obligation. The HCE consultant’s professional obligations were compromised because of competing personal obligations. She was not able to allocate the time necessary to properly conduct the consultation. It might have been more appropriate to inform the resident that more time would be needed before the HCE consultant could provide a thoughtful reflection on the case.

Case Study 1: Discussion (continued)
Competent HCEC processes include reviewing the medical record and interviewing involved parties. As part of the information-gathering process, the HCE consultant should interview relevant healthcare team members. In this case the HCE consultant should have anticipated that the social worker and attending physician would be valuable informants who could contribute to wise management of the case. It is atypical that an ethics consultation analysis needs to be done urgently. Careful analysis and reflection typically take time. Especially in an end-of-life situation, it is essential to consider all relevant sources of data and not just the information provided by the requester. When in doubt, it is prudent to err on the side of preserving life until a careful analysis can be completed, with the understanding that withdrawal of treatment can happen at a later time.

Case Study 2 A novice HCE consultant is acting as the lead HCE consultant for the first time. He receives an HCEC case involving a patient who is dead according to neurological criteria but who remains on mechanical ventilation. The patient’s wife asks the physician about post-mortem sperm retrieval. The physician seeks advice from the HCE consultant, who is unacquainted with this ethical issue. The consultant provides advice without reviewing the bioethics literature or determining whether ethical consensus on the issue exists. Exercise: Which, if any, of the responsibilities in the Code were violated?

Case Study 2: Discussion
This case involves issues of competence and integrity. HCE consultants must identify sources of relevant information necessary for them to competently conduct an ethics consultation, including relevant policies, professional codes and guidelines, published literature, and precedent cases.

Case Study 2: Discussion (continued)
Professional integrity involves commitment to HCEC’s core values and cultivation of attributes, attitudes, and behaviors (e.g., self-awareness, fair-mindedness, humility, moral courage) that enable one to perform HCEC well. HCE consultants must recognize when an issue is outside the scope of their knowledge and seek assistance. Novice HCE consultants should seek guidance from mentors to ensure that HCEC-related competencies are being cultivated. The obligation to communicate responsibly applies to both internal and external communication.

The Future of the Code of Ethics
The Code of Ethics will evolve as the profession evolves. The Code of Ethics is one piece of an overall effort to professionalize the practice of HCE consultation. Work in the field remains to be done: Identification of a process to address code breaches Accreditation of programs that train and educate HCE consultants Certification or quality attestation of individuals who practice HCE consultation Accreditation of consultation services The Code is meant to be a living document. The Code is the foundation; however, ASBH is not currently planning to operate as an enforcing body. More work needs to be done in the field.

References American Society for Bioethics and Humanities. (2011). Core Competencies for Healthcare Ethics Consultation (2nd ed.). Glenview, IL: Author. American Society for Bioethics and Humanities. (2014). Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants. Chicago, IL: Author.

Recommended Reading Carrese, J. A., & Members of the American Society for Bioethics and Humanities Clinical Ethics Consultation Affairs Committee. (2012). HCEC pearls and pitfalls: Suggested do’s and don’t’s for healthcare ethics consultants. Journal of Clinical Ethics, 23(3), 234240. Tarzian, A. J., Wocial, L. D., & the American Society for Bioethics and Humanities Clinical Ethics Consultation Affairs Committee. (2015). A code of ethics for health care ethics consultants: Journey to the present and implications for the field. American Journal of Bioethics, 15(5), 3851. doi: /

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