Abstract
Clinical ethics consultation has come a long way. The 1980s and 90s witnessed the birth and growth of hospital ethics committees. In 1990, 60% of hospitals had an ethics committee (American Hospital Association 1985, 60) and in 1992, the Joint Commission for Accreditation of Healthcare Organizations (JAHCO) issued standards requiring that health care organizations “have in place a mechanism for the consideration of ethical issues arising in the care of patients” (Joint Commission 1992, 104). Clinical ethics committees were widely available before the turn of the century, offered in over 90% of U.S hospitals (McGee at al. 2002, 76), and in 2006, the Joint Commission required that all U.S hospitals develop standards, “processes and activities related to ethical care” (Joint Commission on Accreditation of Healthcare Organizations 2006, Standards RI.1.10-RI.2.100). In 1998, a survey was conducted (Fox 2007) that revealed tremendous variation in approach and very limited training for ethics consultants. At that time, only 5% of consultants had completed a Fellowship for graduate program and 45% had had no formal direct supervision and training by an experienced consultant. Since then, more Fellowships have come into existence, more graduate programs, and more opportunities for training in clinical ethics. […]