Ethics Services

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.