Date of Award

January 2020

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Gary S. Kopf


Aims: The principal aim of this study was to investigate how a policy used to address inappropriate patient treatment functions at our institution. Specifically, we were interested in how the Conscientious Practice Policy (CPP) was used in ethics consultations, and what were the overarching subjective opinions on its use and effectiveness. The CPP is a hospital policy used by providers to limit or withdraw care during circumstances where there is a question about the appropriateness of that care. The ethics committee sometimes suggests using this policy during ethics consultation. Other institutions have similar policies. Additionally, we aimed to describe the breadth of ethics consultations at our hospital. Methods: We took a mixed methods approach to investigate the question. A comprehensive review of all ethics committee consultations between 2013 and 2018 was used to create an ethics committee consultation database with consultation information, consultation outcomes, and patient information. The ethics consultation database was used to identify those patients with CPP use, and summary statistics were generated for all consultations. Focus groups concerning the CPP were then held with committee members and critical care attendings following the study period in 2019. Focus group transcript results were coded into common themes using a conventional analysis approach. Results: We reviewed 178 consultations over the study period, of which 176 consultations represented patient encounters. Of these, 42 cases involved the CPP (23.9%). For most cases, the policy was simply considered and discussed by the team, but in 10 other circumstances it was used more extensively (5.7%). The themes from the focus groups included 1) Mixed perceptions of provider-family/surrogate communication prior to invoking CPP contribute to complexity in decision-making regarding CPP use; 2) Feelings of ineffectiveness in using an ethics consultation to decide on CPP use; 3) Feeling the necessity of addressing moral distress in the absence of a policy; and 4) Inconsistent policy use for different patients based on degree of surrogate/family persistence in resistance, providers’ comfort with directly making decisions, and bias towards certain groups. Conclusions: The CPP was considered with unexpected frequency, although rarely executed after consideration. Focus group themes suggest the CPP is an ineffective tool for rationally resolving conflicts over the appropriateness of care.


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