The purpose of this study was to describe the process used by ethics consultants to resolve conflicts in end-of-life decisions. The study utilized a descriptive correlational retrospective survey design to investigate the process of ethics case consultation. A survey questionnaire, developed for this study, identified 58 process items derived from the literature on ethics case consultation and mediation. Using a four-point Likert scale, respondents indicated the frequency of occurrence of the process items based on their experience. The non-random sample of 289 respondents were members of the Society for Bioethics Consultation (SBC).

Data analysis was based on a response rate of 74%. Demographic results were consistent with SBC membership. The content validity and internal consistency reliability of the survey questionnaire were supported in the factor analysis of the 58 process items, which yielded six factors with eigenvalues of 2.0 or greater and accounted for 48.5% of the variance. The individual alpha reliability scores for these six factors ranged from.92 to.68.

Further analysis indicated that ethics consultants use a consistent and identifiable consultation process that has three phases: Intake, Discussion, and Follow-Up. In the Intake phase, information is gathered from the parties involved in the case. The Discussion phase reflects a facilitated, mediation-oriented discussion that is fact-based, inclusive, patient-centered, and morally reflective. Conclusions in the discussion are non-binding recommendations reached by consensus. The Follow-Up phase of consultation includes contact with many of the parties involved and assessment of the consultation by them.

Due to the limitations of the study, (a new instrument and a non-random sample) one cannot generalize that all ethics consultations adhere to the process identified in the study. The implications for nurses who provide ethics case consultation include the encouragement to promote their perspective of patient advocacy, their commitment to working with other professionals, and their strong training in interpersonal communication skills.