TABLE 3.

Summary of Written Protocols

Hospital Protocol	Reason for Mandatory Consult	Consult Trigger Category	Mandatory Language
1	“…attending physician objects to a surrogate’s decision to withhold or withdraw artificial feeding and hydration for an adult who is not terminally ill or permanently unconscious…”	Request for potentially inappropriate treatment, including end-of-life care dispute	“…in certain … circumstances must the Ethics Review Committee convene … when a patient lacks decision-making capacity.”
2	“…consensus regarding an order to withhold or withdraw treatment does not exist … or that a physician is unwilling to abide by a patient’s Advance Directive or the direction of the patient’s surrogate decision-maker…”	Request for potentially inappropriate treatment, including end-of-life care dispute	“An involved party should seek an ethics consultation…”
3a	“Disagreements in determining what constitutes non-beneficial treatment may arise between the patient or patient’s surrogate and healthcare providers.”	Request for potentially inappropriate treatment, including end-of-life care dispute	“…attending physician shall request an ethics consultation.”
3b	“…treatment decisions on behalf of persons who lack healthcare decision-making capacity and for whom there is no surrogate decision maker.”	Medical decision-making for unrepresented patients lacking decision-making capacity	“Ethics consultation will be obtained.”
4	“…situations which are not life-threatening emergencies, if the patient has no known relatives and none can be found after reasonable attempts to locate them…”	Medical decision-making for unrepresented patients lacking decision-making capacity	“…an Ethics consult shall be requested…”
5	“…decisions by external social workers serving as proxies if the proxy requests withdrawing or withholding of life-prolonging treatment.”	Medical decision-making for unrepresented patients lacking decision-making capacity	“A physician or designee on the case must email (from secure system) the chair of the Ethics Committee … as appropriate … the chair can agree with the decision to withdraw or withhold treatment.”
6	“Posthumous/live sperm procurement…”	Posthumous sperm donation	“Ethics committee consultation must be obtained…”

Reasons for mandatory consults are quoted directly from submitted protocols. One institution submitted two separate protocols (3a and 3b).