From Acute Events to Chronic Disease Conditions: An Integrated Model for Ethics Consultation Along the Continuum of Care

"The Ethics Consultant (EC), where present, is called on to offer a resolution to ethical dilemmas at different times over the course of treatment. However, it is not yet clear under which particular circumstances the intervention of the EC should be requested when chronic diseases occur following an acute event. As part of the treatment of these evolutionary chronic conditions, the pathway is often complex and may involve multiple actors (i.e. departments, hospitals, and others). The role of the EC is often limited to a single department and to an isolated event. Therefore, there is frequently no possibility to take into consideration all of the options inherent to the entire continuum of care and of their consequences for the patient. From intensive care units, rehabilitation wards, long-term hospitalization, through to palliative care, the pathway presents important ethical-clinical questions for the patient, for the healthcare team, and for family members. For these reasons, our objective is to develop a model of consultation integrating the EC along the continuum of care. By analyzing a series of cases, we developed an integrated model of consultation allowing the EC to intervene at different subsequent stages of the process. Our findings suggest that this model is an effective means to allow the EC to provide support in relation to single events but also to coherently pursue – within a collaborative setting across different departments – a specific course of treatment which is respectful of clinical indications and of patients’ and caregivers’ preferences along the whole pathway. "