Complex bioethics consultation in rural hospitals: Using telemedicine to bring academic bioethicists into outlying communities

Bioethics consultations are necessary to ensure excellent patient care and all US hospitals are required to provide access to bioethics consultants for cases raising ethical or moral dilemmas. However, there is a paucity of trained clinical ethicists. While assistance from trained bioethicists may be obtained via telephone or email, such methods of contact do not allow a bioethicist to engage fully with all members of the health-care team, the patient and family members. In two recent cases, rural hospitals contacted our centre for assistance with complex ethics cases. We provided a clinical ethics consultation via videoconferencing. The outcomes of the consultations would probably have been inferior had they been performed via telephone. For example, the non-verbal cues allowed the consultants to have a better understanding of the team dynamics, and led them to ask important questions that directly affected the recommendations which were made. Because patients are likely to benefit significantly from access to bioethicists when ethical questions arise, rural and community hospitals should consider teleconsultation when local ethics committees decide that further assistance is warranted.