Medical Ethics Unpacked: Clinical Ethics Consultation in Practice

In this episode of Medical Ethics Unpacked, Dominic Sisti, PhD, a bioethicist from Penn Medicine, speaks with Aliza Narva, JD, BSN, MSN, director of ethics at the Hospital of the University of Pennsylvania, about the practical realities of clinical ethics consultation. Co-host Steve Levine, MD, from Compass Pathways, was unable to join the recording, and Sisti leads the discussion solo with Narva on how ethics teams function within complex hospital environments.

Narva describes clinical ethics consultation as a structured, case-based process that typically begins with a clinician identifying uncertainty or discomfort in care. Requests most often come from residents and nurses. From there, ethicists review the medical record, speak with members of the care team, and, when feasible, include patients and families. She notes that consults frequently reflect communication gaps across teams rather than purely ethical disagreements.

The conversation highlights differences between traditional consultation models and mediation-based approaches. Traditional models often emphasize policy, prior cases, and ethical literature to determine an appropriate recommendation. In contrast, the mediation model focuses on bringing stakeholders together to clarify values and surface assumptions driving disagreement. Narva suggests that many cases shift once all parties are in the same conversation.

Common consult themes include end-of-life decision-making, surrogate disputes, and clinician moral distress. She emphasizes that ethics consultants are often called when clinicians feel constrained or uncertain about next steps.

The discussion also touches on system-level challenges, including pandemic-era visitation policies and their downstream effects on communication and trust. Narva reflects on how rapidly changing policies during COVID-19 exposed tensions between safety, access, and patient-centered care.

Narva stresses that ethics consultants do not issue binding decisions. Their role is to clarify ethical considerations, support communication, and help teams identify workable paths forward within clinical and institutional constraints.

“Ethics consultants don’t have any powers. We’re consultants,” Narva says. “I’m there to outline what our ethical obligations are, do some creative thinking… and make suggestion[s]…but I can’t sign anyone’s permission slip.”