Emotion, Reason & the Ethics Consult

Over the coming weeks, I hope to share key take-aways from the Harvard Center for Bioethics’ three-day course in clinical bioethics. 

Here’s a start. At Massachusetts General Hospital, Guy Maytal holds these titles: associate director of ambulatory psychiatry, director of primary and urgent care psychiatry, and psychiatric liaison to palliative care. He also is involved in ethics consults.

You wear that many hats, there is bound to be confusion: So it’s not unusual for him to be called for a psych consult on what is essentially an ethics matter, or for an ethics consult on a psych matter. The lines blur. Maytal once received a call for a consult “because the patient cried.” Which says more about a clinician’s inability to sit with emotion than with any problem on the patient’s part.

Maytal’s lecture at the Harvard bioethics course focused on reason and emotion in clinical ethics and included this useful insight: “In the brain, there is no division (between reason and emotion); there’s a balancing act.” 

Maytal is a masterful lecturer. Here are his essential tools for an ethicist in a consult:

• Bring awareness to your reactions
• The role is the target, not the individual
• It's not personal
• What do I make it mean?
• Patients come not with problems, but with solutions that no longer work

The patient perspective in that last one puts into context how a clinician might confuse psychology and ethics consults. The lines blur, indeed.