Bridging Social Work and Clinical Ethics

Social workers and other healthcare professionals are trained to think about patient advocacy, but patient advocacy is not often discussed openly in the field of clinical ethics and there is not agreement among ethics consultants as to whether it is appropriate for ethics consultants to act as patient advocates. An issue of The American Journal of Bioethics was devoted to the topic in 2012 in an attempt to foster dialog around this overlapping of roles.

Bioethics fellow Tracy Brazg, MSW, MPH, who is a social worker, has focused her master’s thesis research on the dilemma that consultants in clinical ethics are responsible for two potentially conflicting actions:

  • To recognize and address power imbalances that exist between patients and providers
  • To facilitate neutral deliberation on the ethical issue at hand

Patient advocacy is one tool for addressing the power differentials that are inherent in the everyday delivery of healthcare. Patient advocacy, however, is not a neutral activity. What does it mean, then, to introduce the concept of patient advocacy into clinical ethics consultation (CEC)? Who should take on the role of patient advocate, if one is needed during ethical deliberation? Is it ever appropriate for an ethics consultant to advocate on behalf of a patient involved in a consultation? With Center Director Benjamin Wilfond, Brazg is delving deeper into this issue in a systematic way.

In reading through the controversy amongst ethics consultants, Brazg noticed that patient advocacy was defined differently across much of the published literature. To be able to make an argument for or against patient advocacy in ethics consultation, she felt it was necessary to gain more clarity on the concept. To do this, Brazg returned to the bioethics literature along with that of social work, a profession predicated on a long-standing foundational commitment to serving the most vulnerable members of society (and notably a disciplinary perspective that was missing from existing commentary on the topic). She reviewed both bodies of literature on patient advocacy over the past 20 years.

Her analysis identified four approaches to patient advocacy that are relevant to the contexts of CEC. Along with advocating for a patient’s best interest, representing a patient’s wishes and helping to protect a patient’s rights, the review of the social work literature on patient advocacy revealed an additional approach that is relevant to the role of clinical ethics consultants: empowerment. Brazg presented the results of her research at the International Conference for Clinical Ethics Consultation in April 2014.

“Ethics consultations often happen in a context of power imbalances between patients and providers. People who are sick are often vulnerable. As consultants, we can’t remove ethical deliberations from that context of power differential, but we can try to make sure that all parties feel empowered to share their side of the story.”

Tracy Brazg

Ultimate Goal

To clarify the concept of patient advocacy as it relates to clinical ethics consultation, and to provide practical guidance for clinical ethics consultants and others involved in ethical deliberation.