Clinical Ethics Consultations in Cirrhosis Care.

Abstract

Background: Ethics consultations may reflect the nature and frequency of conflicts in clinical care. Data regarding consultations for patients with cirrhosis, however, are limited.

Aims: To understand the reasons and context for ethics consultations and identify areas for improvement.

Methods: We evaluated inpatient ethics consultations from 06/2015 to 08/2023. Consults for people with severe liver, heart, and lung diseases were examined for the reasons and contextual factors for consultation. These were coded according to a qualitative conceptual content analysis by two independent reviewers. The rate of consultations was derived from the denominator of hospitalized patients with each condition over the same time.

Results: During the study period, there were 38 ethics consults from 17,460 patients with liver disease (incidence 0.2%) and 96 among 48,394 patients with heart/lung disease (incidence 0.2%). The primary ethical issue was surrogate decision-making related to the lack of an identified durable power of attorney or when surrogate decision-making went against care team recommendations. These conflicts were twice as likely for patients with cirrhosis. The second most common primary ethical issues were code status and futility. Medical error, symptom management, and withdrawal of life supports were not associated with ethics consults. Legal issues were more common in patients without cirrhosis. Communication disputes with the team, intra-family disputes, and quality of life concerns were the most common contextual factors.

Conclusion: Ethics consultations for patients with cirrhosis occur for 0.2% of hospitalizations and are linked to deficits in advanced care planning, poor communication, and poor patient quality of life.