Seek Consultation

Seeking consultation commences with the recognition that seeking consultation is itself an ethical duty to the client. The chapter recommends three types of consultation, including ethical consultation, clinical consultation, and legal consultation. Ethical consultation occurs best when it is regularly scheduled, part of an ongoing relationship, and nurtures the professional’s own ethical growth. Clinical consultation can be used for ongoing supervision, understanding the connection between emotional and academic problems, staying current with clinical theory and interventions, recognizing the need for self-care, and managing clinical concerns. Legal consultation can assist with understanding constitutional rights of due process and equal protection, federal statutes such as the Every Student Succeeds Act or Individuals with Disabilities Act, state statutes, administrative regulations, and case law, such as the Tarasoff duty to protect and Jaffee v. Redmond. It ends with a discussion of the relationship between law and ethics and provides guidance regarding civil disobedience.

Physicians and Patients Perception of a Problem as Ethically Relevant in Oncohematology: Only a Question of Perspective?

Ethical issues are connatural with the medical activity. Moral questions regarding some medical specialities as obstetrics or pre or perinatal medicine are well known. Nevertheless few is known about ethical problems perceived as remarkable from physicians and patients in onco-hematology. This is a retrospective monocentric descriptive study. Its purpose is to recognize, in oncohematology, what are the problems perceived as ethically relevant both from physicians and patients. Ethical issues regarding onco-hematologic patients were recognized consulting clinical diary of 100 patients treated in our institution. Patients have casually been selected in the temporal period from January 2004 to June of 2008. Ethical questions were listed in two groups: those perceived as remarkable for the physicians and those for the patients. Median age of the patients was 54.5 years (R 33–86). M/F was 55/45. Sixty-one patients were affected by chronic or indolent hemopathies. Sixty-six patients received 1st line therapy, instead 34 2nd line or superior. Seventy-five patients had primary school instruction, 22 secondary, 3 had got a degree. Eighty patients were assisted by a relative. Twenty-nine patients perceived a problem as ethically relevant (5 compliance to treatments; 5 refusal of treatment; 7 intolerance to hospitalization; 9 scarce trust in caregivers; 3 difficulty to understand the therapeutic plan). In 38 cases physicians perceived a problem as ethically relevant (8 over treatment; 7 type of treatment to adopt; 8 correct timing of therapy; 11 correct use of resources; 4 adequacy of treatment). Physicians perceived these problems mainly about patients requiring 2nd line treatment or further (28 cases out of 38). In 12 cases only patients perceived a problem, in 21 cases only physicians perceived a problem, while in 17 cases a problem was perceived as ethically relevant by physicians and patients simultaneously. In our study, in onco-hematology the main issue perceived by patients as ethically relevant is the scarce trust in caregivers, while for physicians it is the correct use of resources. Physicians perceive an ethical problem mainly considering patient candidate to 2nd line treatment or further. In 24% of cases, a problem perceived as ethically relevant by patients is underestimated by physicians. In this contest the possibility of an ethical consultation within a clinical counselling might create a convergence between physician and patient perspective.