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The Impact of Clinical Ethics Consultations on Physicians in a Latin American Context

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Abstract

Clinical bioethics plays a significant role in hospital settings through bioethics consultations, which focus on providing ongoing assistance in complex situations within the doctor-patient dynamic. These consultations entail regular interaction between physicians and clinical bioethicists. This situation prompts an exploration into how bioethics consultations affect physicians. The current research aims to understand the influence of bioethics consultations on physicians’ bioethical knowledge by analyzing the lexical content in their patients’ medical records. Medical records are a synthesis carried out by physicians, often reflecting collaborative efforts, and capturing verbal statements indicative of thought processes suggestive of learning. The study is a sequential mixed-methods design with a retrospective descriptive approach, comparing medical records from the early years of the Department of Humanism and Bioethics’ operation (2013–2015) to the more recent ones (2019). Technical bioethical terminology such as “therapeutic effort limitation,” “futility,” “beneficence,” and “respect for autonomy” is more prevalent in recent medical records. This trend may stem from the positive impact of bioethics consultations conducted by the Department, with haptic communication serving as a particularly effective form of interaction with others during experiences of moral distress. This appears to be characteristic of cultures like those in Latin America.

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Notes

  1. The italics are ours. There exists a history of imitative relationships between Euro-North America and Latin America, where Latin America follows Euro-North American proposals as mere application of these to its context, suggesting an abstract universalism of these proposals that assumes their application in any context (de Zubiría-Samper 2021). This kind of attitude does not recognize the influence of the context, cultural variations, and the dynamism of society (“it suppresses differences and makes the sociocultural context's relevance in mediating knowledge, discourses, and practices invisible” (de Zubiría-Samper 2021, 70).

  2. An individual analysis of the doctors was not conducted due to the comprehensive patient record’s mixture between clinical care provided by individual subjects and care delivered by groups of professionals. In other words, there are annotations in medical records made by a single professional, while others, even though attributed to an individual, are the result of discussions among a group of professionals and graduates and trainees who discuss the case. On the other hand, specialization-based discrimination would also introduce bias, as the described specialties involve rotations of students training for other specializations. This prevents establishing a direct relationship between the indicated specialty and the presence or absence of technical language.

  3. We also have consultations carried out by outpatient patients, as well as other forms of intervention by the H&BD such as talks, workshops, case reviews, which are not analyzed here.

  4. “On many occasions, for instance, in the face of requests for futile treatment, family members making these demands hold a perception of these treatments as beneficial for the patient, overlooking all that clinically involves administering a treatment marked as futile by the professional. In such cases, the bioethicist explains—educates—the family members about the negative implications of the treatment that seems beneficial on the surface. In other words, the bioethicist resignifies the family members’ mistaken perception of the treatment” (Prieto et al. 2020, 203-204).

  5. The third one is cognition (Giampaolo and Camilla 2018; Kochanska et al. 2005).

  6. The author cited in this paper suggests using happiness and well-being as synonyms, although he points out some differences between them (Rojas 2021).

  7. The Happy Planet Index (https://happyplanetindex.org/) assesses the subjective perception of well-being. Colombia is consistently within the top 10 and in 2019, it ranked third.

  8. The relationship established between per capita income and progress with happiness is strong and appears justified in low-income countries like Colombia. High levels of poverty in communities create conditions of vulnerability that lead to situations of risk (Ortega Londoño et al. 2019), contexts of poor mental and physical health, and the risk of human rights violations. All of these factors affect well-being or happiness (Graham and Felton 2005).

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Acknowledgements

We express our gratitude to the Fundación Santa Fe de Bogotá University Hospital for making the development of this study possible. This research had no sources of funding.

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Authors and Affiliations

  1. Humanism and Bioethics Department, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia

    Nathalia Rodríguez-Suárez & Paula Prieto-Martínez

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  1. Nathalia Rodríguez-Suárez
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  2. Paula Prieto-Martínez
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Contributions

NR-S: substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data;  drafting the manuscript and revising it critically for important intellectual content;  final approval of the version to be published.  PP-M:  substantial contributions to conception and design; revising the manuscript critically for important intellectual content;  final approval of the version to be published.

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Correspondence to Nathalia Rodríguez-Suárez.

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This study was approved by the Institutional Ethics Committee (IRB) under official letter CCEI-12317-2020 and by the Research Ethics Committee of the hospital, being a secondary data analysis study, it was exempt from informed consent.

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The authors declare no competing interests.

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Rodríguez-Suárez, N., Prieto-Martínez, P. The Impact of Clinical Ethics Consultations on Physicians in a Latin American Context. ABR (2024). https://doi.org/10.1007/s41649-023-00271-4

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