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Consultation Process

The Consultation Committee assists patients' families and caregivers in making difficult ethical decisions. Consultations are provided to programs affiliated with Legacy and are supervised by certified ethicists and staffed by a multidisciplinary team of trained consultants.

Access to Consultation

Any individual (health care team member, patient, family) requesting consultation may do so by calling the hospital operator and asking for the Ethics Consultant on call.


All requests involving ethics issues are accepted for consultation. Ethical issues are addressed by one of three levels of consultation (described below). The Consultant determines the level of consultation and if ethics issues are involved. Level I consultations may be managed by the consultant alone or with help from the team. Some Level I and all Level II and III consultations require help from the team. The Consultant contacts the other team members on-call to decide on the process of the consultation. All ethics consultations are reviewed by the Ethics Consultation Committee and go through a quality improvement process.

Level I Consultation

This level of consultation requires answering a relatively simple question by any Clinical Ethics Consultation Service (CECS) member. Further education and literature may be provided. The ethics consultation does not require ongoing involvement or acknowledgment in the medical record. The CECS member reviews the consultation and recommendations retrospectively with the Ethics Consultant on call.

Level II Consultation

This level of consultation requires facilitation of the decision-making process with the health care team, patient, and/or family and is performed by the ethics consultant on call with help from the CECS team. The consultant is responsible for assuring notification of all parties about the consultation request, including the attending physician if applicable. Parties may decline to participate. The consultant supervises information gathering from the patient's medical record, physicians, nursing staff, housestaff, the patient and the family as necessary. The consultation, recommendations, and level of consultation are reviewed weekly until the case is resolved by the ethics consultation team for quality assurance purposes. An evaluation sheet is completed and reporting is performed monthly to the Ethics Program and periodically to the Quality Council.

Level III Consultation

This level of consultation requires a full CECS process and is facilitated by the on-call Ethics Consultant with help from the CECS team. The consultant on-call is responsible for assuring notification of all parties about the consultation request. Consent from the parties is needed before the consultation may proceed. The Consultant On-Call is also responsible for supervising extensive data gathering, documentation, and presenting information to the CECS.

Description of Models to Evaluate Health Care Ethics Issues

There is great diversity in the types of health care ethics issues that are challenging today's clinicians. Most times the clinician is able to evaluate and manage these issues without needing an ethics consultation. When the need for ethics consultation arises, the type of health care ethics issues may be better addressed by choosing the optimal model of analysis. Different models include: the Jonsen matrix, the balance of burdens and benefits, analysis of ethical principles, narrative model, assessment of relationships, casuistry, and the cost-benefit matrix.