PHYSICIANS often have turned to psychiatric consultants for "help and guidance with morally troublesome cases," in which the consultant may be "expected to fill a mediating role, often... to persuade the patient or family to act in a certain way." The result may be that the "psychiatric consultation mask[s the] moral dilemmas" so that the ethical dimensions of the case are overlooked by both the primary physician and the psychiatrist.1
In the last decade, ethics consultation programs in hospitals have proliferated.2 The Joint Commission on Accreditation of Health Care Organizations now requires that accredited hospitals in the United States have "a functioning process to address ethical issues."3
Perhaps for these reasons there is now a tendency for ethics consultations to mask psychiatric questions. Three examples will illustrate this problem. All three cases arose within a single week at a single institution, a tertiary care teaching hospital in
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