Bioethics

The Spectrum Biomedical Ethics program is handled by the Stanford Center for Biomedical Ethics (SCBE). The Center

• provides clinical ethics consultations.
• provides research ethics consultations to basic science and clinical researchers whose projects raise ethical and social concerns.
• is dedicated to interdisciplinary research and education in biomedical ethics.
• serves as a scholarly resource on emerging ethical issues raised by medicine and biomedical research.

The Stanford Center for Biomedical Ethics has played several valuable roles at the Medical School, providing ethics education, coordinating bedside ethics consults and hospital ethics committees, and doing cutting-edge research on ethical problems in our health care system. The Center has a dual focus, working on both clinical medicine and basic biomedical science.

The Ethics Committee of the Stanford Hospital and Clinics provides a medical ethics consult service for the hospital and clinics. Anyone may request a consult.

Ethics consults usually involve a situation where patient care is impacted by conflicts in values between and/or among patients, families, and treatment providers.

Ethics consults consist of a process whereby facts are gathered from all relevant persons, values are elucidated and prioritized, and recommendations made so as to honor as much as possible the priority of values.

Who can use the consultation service?

Anyone, including

• patients or their families
• nurses
• allied health care professionals
• staff
• physicians

Who staffs the consultation service?

In most cases, ethics consults involve a multidisciplinary team of persons from the ethics committee led by a member trained and/or experienced in medical ethics theory and consult management.

Is a consultation confidential?

Yes; the identities of those requesting consultations and all data, ideas and ethical issues are confidential. With permission of the parties involved, de-identified descriptions of cases may be requested for educational purposes.

What are some examples of situations that may need an ethics consultation?

The issues involved in ethics consultations have included such matters as

• differences of opinion about whether to stop aggressive end-of-life treatment and switch a patient to palliative care only
• whether psychiatric patients can refuse surgery or medical treatment
• uncertainty about who can best serve as surrogate decision maker for an unconscious patient
• disagreements among family members about the treatment choices for an incompetent patient
• demands for treatment that  are considered futile by physicians
• doubts about what treatments are in the best interests of the patient
• uncertainty about treatment choices that are based on religious or cultural imperatives
• the extent to which non-medical facts and circumstances impact a decision to offer organ transplant for a particular patients
• whether a patient is being made to suffer unnecessarily by reducing or withdrawing pain medication
• how to best protect a patient from the harmful acts of a close family member

The Benchside Ethics Consultation Service (BECS) assists investigators with ethical issues in the design of conduct of a study. For example, a consultation could help with:

• analyzing the impacts of a particular policy on the conduct of bench science.
• identifying the ethical or social impacts of conducting a particular line of research.
• suggesting specific actions to minimize risks and maximize benefits to society of pursuing that line of research.

The program allows for proactive identification of important ethical and policy issues in biomedical research. Through early and direct interactions among ethicists, philosophers, social scientists, lawyers, biomedical scientists and others, BECS aims to facilitate discussions with researchers about as-yet-undefined, cutting-edge science as it unfolds.

Stanford University faculty and members of the Stanford Center for Biomedical Ethics staff the service. They are experts in research ethics and regulation, and they represent a wide range of disciplines including biomedical research, genetics, law and philosophy.

Who can use the consultation service?

Any member of the Stanford University community, including:

• Research investigators (the PI or anyone on the research team), study participants, coordinators
• Stanford faculty, staff, scholars, students and medical professionals
• Institutional Review Boards
• Regulatory committees and other institutional bodies

Confidentiality

The identities of those requesting consultations and all research data, ideas and ethical issues are confidential. With permission of the investigators, de-identified descriptions of cases may be requested for educational purposes.

Scope and limitations of the consultation service

Requests that fall under the direct regulation and/or recommendation of another institutional body (such as the FDA, IRB, University Conflict of Interest Committee or OMBUDS offices) will be referred to the appropriate group for further consideration. For example, the consultation service is not meant to supersede the IRB or adjudicate cases of scientific misconduct.

For particularly complex or involved requests, the consultation team may solicit the advice and guidance of an outside group.

Not all cases can or will be dealt with collaboratively; it will depend on the scope and breadth of a particular request and what is reasonably agreed upon by the consultation team and the researchers calling the consultation.

Kinds of research that would be recommended for an ethics consultation

Anyone can request an ethics consultation to get answers to ethical, social, or legal issues that they think might be related to the conduct or implications of their research. The service is not designed to replace the Human Subjects Panel, the Stem Cell Research Oversight Committee, or any other institutional or regulatory body. Some categories of biomedical research raise issues about which there is no clear policy or ethical consensus or that are not addressed by existing regulations.

Examples include:

• Research that could generate incidental findings
• Research that could generate findings of clinical significance to individual research participants
• Tissue/DNA banking
• Research in less developed countries
• Community engagement in research
• Stem cell research
• Pediatric research that is likely to pose more than minimal risk
• Research on identified racial/ethnic groups, and/or indigenous peoples
• Research that is not broadly socially accepted

How consultations are supported

BECS was established as part of CIRGE with a grant from the National Institutes of Health (NIH) and the US Department of Energy (DOE). It is also supported by Spectrum, which is funded, in part, by the NIH Clinical and Translational Science Award.

The Stanford Center for Biomedical Ethics website provides information about events such as:

• Biomedical Ethics Grand Rounds
• Issues in Bioethics Lunch Series
• Jonathan King Lectures
• Medicine and the Muse 

The Scholarly Concentration (SC) program is a required, structured program of study in the Medical Student Curriculum that promotes in-depth learning and scholarship.

Biomedical Ethics and Medical Humanities (BEMH) is a foundation area within the Scholarly Concentration program. This area explores the moral, social, and humanistic dimensions of medicine and biomedical science. Using cross-disciplinary methods such as those from philosophy, social science, film, literature, art, and law, students examine the meaning and implications of medicine and medical research.