Clinical ethics as an important space for reflective engagement with racism in medicine: Evaluating the role of patient race and primary language in clinical ethics consultation

Ethics consultation (EC) supports healthcare professionals, patients, and relatives confronted with an ethical concern or dilemma. There has been significant interest in evaluating the quality of EC services and understanding their structure, processes, and outcomes. Though there has been substantial work in EC quality improvement (QI), the role of EC in promoting equitable care for vulnerable patients—and on influencing diversity, equity, and inclusion in an institution more broadly—has not been sufficiently explored. Additionally, the role of racial disparities in EC trends and outcomes has not been fully elucidated. In this paper, we present the findings of an ongoing QI study of the clinical ethics service of a major urban teaching hospital with the aim of identifying important relationships and themes that bear on the ameliorative role EC can play in promoting antiracism. We studied how patient race and primary language relate to clinical practices and ethics issues and recommendations through observing trends in code status, challenges to decision-making capacity, and length of stay at times of ethics consultation, among other clinical parameters.

Preliminary findings demonstrate that the vast majority of ethics consults involve patients of color and a disproportionate number of non-English speakers. Just as many clinical outcomes are informed by social determinants of health, our study suggests that EC offers an important space for reflective engagement with these elements. Our project also seeks to highlight the need for ethics consultants to attend to both clinicians’ and their own biases and engage with normative issues of systemic racism in medicine.

Isabelle Band – Medical Education – Icahn School of Medicine; Cecilia Katzenstein – Medical Education – Icahn School of Medicine; Julia Kolak – Medical Education – Icahn School of Medicine; Regina Longley – Medical Education – Icahn School of Medicine; Joel Rowe – Emergency Medicine – Mount Sinai Hospital