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Background: Despite the expansion of ethics consultation services, questions remain about the aims of clinical ethics consultation, its methods and the expertise of those who provide such services. Objective: To describe physicians' expectations regarding the training and skills necessary for ethics consultants to contribute effectively to the care of patients in intensive care unit (ICU). Design: Mailed survey. Participants: Physicians responsible for the care of at least 10 patients in ICU over a 6-month period at a 921-bed private teaching hospital with an established ethics consultation service. 69 of 92 (75%) eligible physicians responded. Measurements: Importance of specialised knowledge and skills for ethics consultants contributing to the care of patients in ICU; need for advanced disciplinary training; expectations regarding formal-training programmes for ethics consultants. Results: Expertise in ethics was described most often as important for ethics consultants taking part in the care of patients in ICU, compared with expertise in law (p Conclusions: Although many physicians caring for patients in ICU believe ethics consultants must possess non-medical expertise in ethics and law if they are to contribute effectively to patient care, these physicians place a very high value on medical training as well, suggesting a 'medicine plus one' view of the training of an ideal ethics consultant. As ethics consultation services expand, clear expectations regarding the training of ethics consultants should be established.

This paper presents a case for allocating health care resources so as to maximise Quality Adjusted Life Years QALYs). Throughout parallels are drawn with the grounds for adopting utilitarianism. QALYs are desirable because they are essential for human flourishing and goal-attainment. In conditions of scarcity the principle of QALY maximisation may involve unequal treatment of different groups of people; and it is argued that this is not objectionable. Doctors in their dealings with patients should not be continually consulting the principle (though it can sometimes be useful); instead by following existing ethical codes more QALYs will be produced overall. In the formulation of policy, however, the principle should be applied in a thoroughgoing way and, if it is, it will not have some of the counterintuitive consequences it may have in interpersonal situations.

The health select committee expects future demand for long term care to depend on both the rise in the older population and people's health status. The government has encouraged development of the independent sector and there has been a shift in emphasis on caring for older people in their own home, rather than in a nursing home. The NHS was set up to provide health care for everyone from cradle to grave formed on the foundations of justice and beneficence. The idea that no one should be disadvantaged due to circumstances over which they have little control, including age, should be reinstated at the heart of the NHS.

An informal clinical ethics committee was set up to advise on ethical problems in prenatal diagnosis in Leeds. It was used twice in six months but was not called on […]

Patients have the right to accept or refuse treatment. Nurses need to make sure this right is respected. Health-care professionals sometimes believe they can make the best decisions for their [...]

Byline: Patrick Reilly Responding to recent corporate scandals both within and outside the healthcare industry, the American College of Healthcare Executives has shored up its two-page code of ethics by [...]

If I asked you to think about a clinical situation that epitomised an ethical dilemma in critical care, what would come to mind? Would it be about what the critical [...]

The issue of confidentiality with regard to patient care is considered, taking into account complex relationships and sensitive information.

The field of clinical ethics is discussed in the context of particularity and practicality to guide action.

Issues concerning the skills and standards to which doctors should aspire are discussed. The experience of meeting and working alongside doctors treating HIV/AIDS patients in Mumbia, India, is recalled.

Kathy died 18 months ago. She was 28 years old. She had cerebral palsy and a severe learning disability from birth. When she was 4 she developed juvenile rheumatoid arthritis; [...]