Exploring the Role of the Clinical Ethicist

By LOUIS PILLA

The darkest days of the COVID-19 pandemic brought ethical conversations to the fore about allocating scarce resources such as ventilators for acutely ill patients and PPE for clinicians. Such discussions called for the expertise of clinical ethicists, who offered perspectives and insight on these most fateful decisions.

Although those pandemic conversations are in the past, clinical ethicists continue to grapple with issues affecting healthcare delivery. Read on to learn what clinical ethicists do and whether this role might be right for you.

Dealing with “Ethical Angst”

Clinical ethicists are responsible for addressing the ethical issues or challenges that could arise within a hospital or other healthcare organization, according to Connie M. Ulrich, Ph.D., MSN, RN, FAAN, Lillian S. Brunner Chair, professor of nursing and professor of medical ethics and health policy, University of Pennsylvania School of Nursing. Ulrich speaks from deep experience, having been the first nurse trained in bioethics as a postdoctoral fellow at the National Institutes of Health from 2001 to 2003.

think because I saw ethical issues with children and their parents and how parents had to make very difficult ethical decisions, I felt as though I needed to learn more about some of those ethical challenges and how I could best help myself, but also help others in the process,” she says.

Clinical ethicists may be called to consult on or provide an objective analysis of a situation that has created “ethical angst,” she says. For instance, clinicians might struggle with ethical concerns about an endof-life issue or conflicts arising between clinicians, patients, and family members on treatment goals.

During the COVID-19 pandemic, clinical ethicists helped organizations think about handling the influx of seriously ill patients and allocating limited resources, notes Ulrich. Ethicists “were critical to decisions being made within hospitals,” she said in an interview.

Nurses Well Positioned

Most clinical ethicists hold an advanced degree, notes Ulrich. Clinical ethicists can be physicians and nurses with a master’s degree or a doctorate.

“Any nurse should consider this career path,” says Ulrich. “I encourage any nurse interested in ethics or bioethics to consider this career path because I believe they are well positioned to address the daily ethical concerns within hospitals or other organizations.”

Gallup’s annual ranking of professions for having high honesty and ethics. “This sense of trust is key for working collaboratively with other clinicians, patients, and their families on some of the most difficult decisions they often have to make,” says Ulrich.

Clinical Ethicists and COVID-19

During the COVID-19 pandemic, clinical ethicists faced a series of perhaps unprecedented challenges. A study authored by Ulrich and others published earlier this year in AJOB Empirical Bioethics detailed five themes:

• ethical issues that were increasingly more complex

• moral distress that was “endemic”

• shifting ethical paradigms from the focus on the individual to the population

• fostering a supportive environment

• organizational ethics: variation in the value, roles, and policy input of clinical ethicists.

“Nurses are also excellent listeners,” says Ulrich. “They’re organized and systematic in their thinking. These characteristics are all very good and important for conducting an ethical analysis.”

“We also live in a very diverse society,” she notes. “So, I would argue that we need individuals who can bring different cultural and social perspectives to the complex ethical challenges the public faces.”

“The most significant finding for me was the sense of profound moral distress that we did see from nurses and physicians,” says Ulrich. “Clinical ethicists were feeling morally distressed as well. And in many ways, we were unprepared for the physical and emotional toll the pandemic has taken on the healthcare team.”

Dealing with Risks

As to her background, Ulrich trained as a pediatric nurse. “I

For one thing, nurses remain the most trusted profession in the U.S., as they have year after year. In Gallup’s annual rating of the honesty and ethics of various professions published in January 2022, for the 20th straight year, nurses led

Nurses can gain experience in this field by serving on an ethics committee, Ulrich notes. They can become “an excellent resource for others on their unit who might have ethical issues and concerns.” She notes that most hospitals have an ethics committee, though that can vary depending on geography.

“One of the issues that I’m still not settled with is how much risk nurses should accept when they were placed at risk within their organizations because of a lack of personal protective equipment and other resources,” Ulrich says. “That was a major theme that we heard from clinical ethicists.”

“Certainly, I know from my nursing practice that there are inherent risks in being a healthcare provider, and to some degree, we accept those