The Bioethics Program at the Icahn School of Medicine at Mount Sinai (ISMMS) provides consultation and guidance about bioethical issues that inevitably arise in the course of patient care, research, and the use of animals in research.
Any health care professional including, house staff, attending or consulting physicians, nurses, genetics counselors, social work, patient representatives may contact the ethics consult service. A consult may also be initiated by a Mount Sinai patient or family member.
When a difficult decision needs to be made about a case or a policy, the Ethics Committee is available to help:
- Clarify the ethical question at hand.
- Promote discussion of responsibilities and standards related to patient care.
- Encourage shared decision making among patients, families, and their healthcare team.
- Make recommendations to the individuals involved.
- Provide moral support for a team in a difficult decision.
Whenever there is uncertainty as to what is the right thing to do:
- The case is ethically challenging, unusual, unprecedented, or especially complex.
- Initiation of a new treatment option requires policy guidance.
- A patient is no longer able to communicate, and there is a question about who should make his or her healthcare decisions.
- A patient’s surrogate decision maker is unable or unwilling to provide a decision as to what the patient would have wanted.
- Decisions need to be made about life-sustaining treatment for a patient who lacks decision-making capacity and for whom an appropriate surrogate decision maker cannot be found.
- A Surrogate’s decision to withdraw or withhold life sustaining treatment does not meet the standards of:
- Treatment would be an extraordinary burden to the patient and not in accord with accepted medical standards.
- The patient’s injury or illness is expected to cause death within six months.
- OR the patient is permanently unconscious.
- OR the treatment would be inhumane and extraordinarily burdensome AND the patient has an irreversible or incurable condition.
- There is uncertainty about whether life-sustaining treatments (i.e., feeding tubes, ventilators) should be used, started, continued, or ended.
- Family members disagree with their loved one's decision to start, continue, or end treatment.
- A patient or family members is uncertain about what to do.
- A patient refuses treatment that has the potential to be medically helpful.
- Health care providers want to discuss and formulate a plan that could help to avert an “ethics emergency.”
An ethics consult may also be requested whenever there is disagreement about what is the right thing to do:
- Efforts by patient, family and health care providers to resolve an ethical issue have reached an impasse.
- A patient feels that he or she is not being offered the opportunity to participate in his or her own healthcare decisions.
- An Attending Physician objects to a surrogate’s decision to withdraw or withhold life sustaining treatment.
- An Attending Physician disagrees with a determination that a patient lacks decision-making capacity.
- Any person on the Surrogate List objects to the designation of the surrogate.
- Any person on the Surrogate list objects to a surrogate’s decision.
- A parent or guardian of a minor patient objects to the decision made by another parent or guardian of the minor.
- A minor patient refuses life-sustaining treatment and minor’s parent or guardian wishes the treatment to be provided.
- A minor patient objects to an Attending Physician’s recommendation about life-sustaining treatment.
Clinical Ethics Consult Service
The Ethics Committee of the Medical Board at the Mount Sinai Hospital provides consultation services for ethical issues concerning patient care.
For consultation, please email brief case information to firstname.lastname@example.org and call The Bioethics Program office:
- The Bioethics Program
After hours and weekends, please call one of the Ethics Committee leads directly:
- Rosamond Rhodes, PhD
Ethics Committee Co-Chair
Phone: 212-241-3757 (office)
- Ron Shapiro, MD
Ethics Committee Co-Chair
Phone: 212-659-9066 (direct) or 212-659-8096 (office)
- Jolion McGreevy, MD MBE MPH
Ethics Committee Vice-Chair
Phone: 212-241-2987 (office)
Research Ethics Consult Service
This service helps clinical and translational investigators to identify ethical issues in their research proposals and design their studies to meet the highest ethical standards. Members of our consult service are available for consultation and guidance. Consultation, provided by Bioethics Program Faculty, is available during the study design process and during the conduct of clinical trials. Investigators may consult the service directly or through referral by a department chair, the Institutional Review Board (IRB), or any one of the other consultation services.
For consultation about issues such as informed consent, research risks, inducements, vulnerable populations, conflict of interest, confidentiality, recruitment, assessment of decisional capacity, and the acceptability of surrogate consent, please contact:
Institutional Animal Care and Use Committee
The Institutional Animal Care and Use Committee (IACUC) is available for consultation and guidance on ethical issues concerning the use of animals in research. Consultation is available during the study design process and during the conduct of studies.
For consultation, please contact:
- Stacey Baker, PhD, IACUC Chair, 212-659-5485
- Janice Gates-Porter, PhD, MOAM. MBA, CM,CET, Notary, Director, 212-241-0153