Ethics Consultations on International Patients at a Quaternary Medical Center in the United States

Objective To characterize clinical ethical dilemmas that arise in the care of international patients in the United States and to propose preventive ethics solutions. Patients and Methods We conducted a retrospective chart review of ethics consultations placed on international patients at a quaternary medical center over a 19-year period (February 8, 2006, to April 5, 2024). Results Forty-nine international patients met inclusion criteria. Most were adults (88%) with a primary diagnosis of malignancy (45%). Most patients came from countries in the Middle East (84%), spoke Arabic (73%), and practiced Islam (86%). The most common reasons for ethics consultation were goals of care/futility (31%), patient autonomy (29%), and allocation of resources/distributive justice (12%). Spiritual or cultural beliefs played an important role in the reason for ethics consultation in the majority (71%) of cases. At the time of final clinical encounter, 47% of patients were chronically ill, 16% terminally ill, 2% healthy, and 35% deceased. Most patients (76%) did not have any advance care planning documentation on file. Conclusion In this study, clinical ethical dilemmas among international patients arose primarily in the context of medical decision making during serious illness and at the end of life. These primarily included ethical dilemmas related to goals of care or futility (eg, withholding and withdrawing life-sustaining treatment) and patient autonomy (eg, family role in decision-making and truth-telling). Spiritual and culture factors were frequently identified as contributing. We discuss preventive ethics approaches in the care of international patients.