Intended for healthcare professionals


Medical ethicists do not conform to stereotypes in ER

BMJ 2000; 320 doi: (Published 29 January 2000) Cite this as: BMJ 2000;320:315
  1. Melanie H Wilson Silver, health care ethics consultant (Snagx{at}
  1. 175 Asbury Road, Egg Harbor Township, NJ 08234, USA

    EDITOR—Having worked in an American hospital for seven years as an ethicist, I find Macnair's assertions in her article on medical ethics to be inaccurate.1

    She states: “US ethicists lurk around the hospital armed with a bleeper waiting to be called whenever an ethical dilemma crops up.”

    We neither lurk in the corridors nor tout for business. Macnair implies that we rush furtively from one potential crisis to another, trying to drum up business like a car salesman. Nothing could be further from the truth. As medical ethics is a fairly new discipline, we are aware of the damage that can be done by a “lone ranger” and work hard to dispel such a stereotype. In fact, patients, families, or members of the clinical team who are in conflict or distressed about a case usually initiate case consultations.

    Additionally, Macnair asserts, without a supporting reference, that medical ethicists “may be given as little as 15 minutes to provide the definitive ethical answers on problems.”

    We do not purport to know or provide definitive ethical answers, should such things exist. The function of an ethicist is to work with ethics committees or the case consultation team to gather relevant information, discussthe issues or principles that may be in conflict, and help those concerned (patients, families, and clinical team members) to reach the best possible decision to meet their needs. Such a process cannot usually be completed in 15 minutes.

    It has been my practice and that of my colleagues to foster an environment in which patients, families, and staff are able to ask for guidance on ethical matters. It is both positive and reassuring for those facing ethical dilemmas to know that help and support are available.

    Clearly, Macnair has had limited exposure to the role of the healthcare ethicist in America and I would caution her not to overgeneralise. Although some people will always practise on the fringe of any profession,I would encourage Macnair to avoid the stereotypes portrayed in Chicago Hope and ER; they are both inaccurate and demeaning.


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