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. 2024 Jan 24;16(4):635–651. doi: 10.1007/s41649-023-00271-4

The Impact of Clinical Ethics Consultations on Physicians in a Latin American Context

Nathalia Rodríguez-Suárez 1,✉, Paula Prieto-Martínez 1
PMCID: PMC11465002  PMID: 39398453

Abstract

Clinical bioethics plays a significant role in hospital settings through bioethics consultations, which focus on providing ongoing assistance in complex situations within the doctor-patient dynamic. These consultations entail regular interaction between physicians and clinical bioethicists. This situation prompts an exploration into how bioethics consultations affect physicians. The current research aims to understand the influence of bioethics consultations on physicians’ bioethical knowledge by analyzing the lexical content in their patients’ medical records. Medical records are a synthesis carried out by physicians, often reflecting collaborative efforts, and capturing verbal statements indicative of thought processes suggestive of learning. The study is a sequential mixed-methods design with a retrospective descriptive approach, comparing medical records from the early years of the Department of Humanism and Bioethics’ operation (2013–2015) to the more recent ones (2019). Technical bioethical terminology such as “therapeutic effort limitation,” “futility,” “beneficence,” and “respect for autonomy” is more prevalent in recent medical records. This trend may stem from the positive impact of bioethics consultations conducted by the Department, with haptic communication serving as a particularly effective form of interaction with others during experiences of moral distress. This appears to be characteristic of cultures like those in Latin America.

Keywords: Clinical ethics, Bioethics consultation, Bioethics education, Morality, Haptic communication

Introduction

The Clinical Bioethics in Latin America: an Educational Approach

Bioethics currently plays an important role in healthcare contexts, which could be linked to the notable presence of technoscientific advances in hospitals (Hottois 2020). Despite this significant relevance, there exists a gap in Latin America between the theoretical aspects of this field of knowledge and its implementation in practice, as described by other authors (Tealdi 2022); practical spaces for clinical bioethics are scarce. In Colombia, the Humanism and Bioethics Department (H&BD) pioneers in this task; it serves as a reference center both in the country and in Latin America concerning clinical bioethics, contributing to the development of national and international initiatives by contextualizing Euro-North American proposals to the South American continent. There is an intention from Euro-North American proposals to be universal and hegemonic (Álvarez-Díaz 2012; de Zubiría-Samper 2021; Quijano 2000; Schramm 2005), but the cultural differences between continents and, of course, between countries, require contextualization. This does not imply a mere application, rather, the sociocultural context constitutes a central mediation in the production of all thought (de Zubiría-Samper 2021, 48)1.

In the clinical encounter involving the bioethicist, questions are posed, often in end-of-life contexts. These issues, which highlight conflicts arising from the possibilities of medical technoscience, currently challenge a prudent clinical practice, creating a scenario in which healthcare professionals need to recognize conflicting situations, such as being in a globalized society and its consequent moral pluralism (Arrieta and Vicente 2013); the exaggerated role of individual autonomy in the Western world (Mackenzie 2010); easy access to often distorted knowledge provided by the digital era (Han 2014); and the difficulties of communication between individuals who have reached the point of denying that exchange that involves dialogue, and are therefore described as the death of conversations (Feinmann 2013); all of this, as noted earlier, in the Latin American context where clinical bioethics is timidly emerging in practical spaces (Tealdi 2022).

All these changes and the resulting new and constant tensions in the clinical encounter have prompted the involvement of the clinical bioethicist in the healthcare professional-patient relationship, described with such importance that it is characterized as a necessity in conflictive situations (Dubler and Liebman 2004; Edelstein et al. 2009). In our hospital, prior to the introduction of clinical bioethics, there were already approaches akin to the role of the clinical bioethicist through Hospital Ethics Committees (Prieto 2017). The advent of practical clinical bioethics in Latin America, despite the existence of these committees, was necessary because there was an urgent need for human resources that could provide constant availability in care (24 h a day, 7 days a week) to support healthcare professionals, patients, and their families, without having to wait for the meetings of the hospital ethics committees. The latter typically convene on a weekly or biweekly basis. This is how clinical bioethics was implemented at Fundación Santa Fe de Bogotá University Hospital (FSFB) in 2013 in the form of the Humanism and Bioethics Department (Prieto 2017).

Having existed for nearly a decade, the H&BD raised questions about its effects within the hospital, particularly the impact of the support provided in the form of “bioethical consultations” on physicians who experience tensions and difficult cases in the clinical encounter, leading them to request such assistance. There is some information regarding the impact of the H&BD, such as evidence of its work being recognized by entities external to FSFB. Another source of information on the impact of the H&BD, both within FSFB and externally, is through the number of bioethical consultations conducted and the record of their quantity over the years. An increasing number of bioethical consultations could indicate the growth of the H&BD (since 2013, the number of consultations has increased by 95%). However, due to the nature of the department’s work, assessing the impact of clinical bioethics consultations goes beyond merely counting their quantity and/or inferring impact from social recognition, both within the institution and externally (by other national and international institutions) of the H&BD’s activities. Therefore, our interest in this study was to understand how bioethical consultations affect those who seek them, with a particular focus on the knowledge that professionals have regarding clinical bioethics. This could be known through declarative knowledge (Carroll 1993), which is essentially the information about concepts, ideas, and facts that an individual stores in their long-term memory (Carroll 1993). In other words, it is possible to investigate the knowledge that physicians have about clinical bioethics through verbal propositions, such as those written in medical records.

The presence of technical expressions of bioethics in the verbal propositions of individuals who are outside the formal academic processes of this field of knowledge (similar to the use of medical terms by expert patients, as observed by Tattersall (2002)) suggests a process of meaningful information appropriation related to lived experiences, accessible through verbal statements such as those recorded in medical records.

The medical records that physicians fill out possess certain characteristics that make them a source of analysis for research as proposed here. Clinicians are trained throughout their careers to extract information they perceive as relevant from a patient to the extent that it can be documented in a record that serves as their means of communication with peers, other professionals, as well as with the patient and their family. Thus, medical records emerge as a form of synthesis of the healthcare process carried out by the attending physician. Consequently, the presence of bioethical language in medical records would imply that this knowledge is recognized by the clinician as having such relevance that it enables communication with peers and other individuals (e.g., not only the patient and the patient’s family but also lawyers, administrative entities, and many others). In this way, verbal propositions not only account for declarative knowledge but, due to the inherent characteristics of a medical record and the information recorded within it, the knowledge contained therein reflects an exercise of synthesis that can also be seen as a process of knowledge appropriation (Giampaolo and Camilla 2018).

The appropriation of knowledge is a form of learning, a process that is influenced by variables such as the motivation of the individual acquiring said knowledge. Regarding the consultations conducted by the H&BD, there exists a context of openness to learning on the part of the listener, in this case: the physician who seeks the support of the H&BD. This is because the emotional tension stemming from the moral stress that typically accompanies the request to consult a bioethicist generates a strong inclination toward meaningful learning (where new knowledge is substantively—not arbitrarily—related to what has already been learned (Ausubel et al. 1976)) in someone who is unsure how to choose the best course of action in a difficult case. Furthermore, the recording of medical records in our hospital does not solely reflect an individual’s process of knowledge, as our hospital is academic, and the notes added to the medical record typically form part of a joint and/or interdisciplinary and/or student-involved discussion process. Thus, it could be said that the medical record in our hospital not only reflects an individual process but also a collective one as well.

Recognizing, as described, that medical records are a form of synthesis carried out by the physician who, in our hospital, represents a team effort, and that within them are recorded verbal statements indicating thought processes suggestive of learning, and that there is a disposition of openness, a motivation to learn about how to choose the best course of action by physicians (and their teams) who fill out these records when their request is motivated by the need for a difficult decision, the present study proposed a lexical analysis of the medical charts of patients whose physicians sought consultation from the H&BD. The complete medical record of these patients was reviewed, excluding the narratives of the consultation conducted by the H&BD because in themselves there is technical language from bioethics. In other words, only the text belonging to the various consultations carried out by the clinicians (treating physician and consultations from specialties related to the patient’s care process) was considered. Therefore, we conducted a qualitative study in search of clinical bioethical knowledge through the verbal propositions written by physicians in the patients’ medical charts.

Materials and Methods

This was a sequential mixed-methods study (Sampieri et al. 2018), employing a retrospective descriptive design, carried out through secondary data analysis. The data sources used included two databases. The first was the H&BD database, which contains all the information related to individuals who attended to since the first bioethics consultation conducted in 2013. The second was the HIS-ISIS hospital database, which holds all the medical charts of patients treated by the institution.

The two databases were used complementarily as follows: the H&BD database allowed for the selection and search of the medical charts of patients attended by the department. Lexical analysis was not conducted on this database, as it is filled out by bioethicists. The analyzed text consisted of the medical records from the HIS-ISIS hospital database of patients who underwent interventions by the H&BD from its inception in 2013 until 2019 (intentional sampling). The entirety of each medical record was considered, except for notes made by bioethicists.

A text analysis was conducted following the processes of axial categorization (Strauss and Corbin 2016) with a sample that allowed for the comparison of the lexical content of verbal statements in the medical charts of patients attended to in the initial bioethics consultations conducted by H&BD (between 2013 and 2015, Group A), with the verbal statements in the medical records of patients attended to in the more recent bioethics consultations (from 2019, Group B), with a 3-year interval separating these two groups.

Since the presence of words related to bioethical topics—the lexical content related to bioethical terms or technical bioethical terms—in the medical charts was the central motivation of this study, two broad initial categories were proposed for this analysis, defined as follows:

  • Lexical content related to bioethics: Lexical expressions associated with bioethical terminology and/or processes addressed by clinical bioethics and compassionate care.

  • Lexical content unrelated to bioethics: Sociodemographic data, patient clinical information, description of the disease process from a clinical perspective, medication formulation/dosage.

No specific pre-defined vocabulary was established for the analysis, in order to allow all vocabulary related to bioethics to emerge from the text of the clinical reports. For the analysis of the lexical content of the consultations, 60 of them were selected—30 conducted from 2013 to 2015 (Group A) and 30 conducted in 2019, randomly selected (Group B). This selection of consultations (all from Group A and a random sample from Group B) is related to the quantity of consultations conducted by the H&BD during those periods. The initial years had few requests (a total of 30 consultations between 2013 and 2015), while 2019 had a higher number of consultations (176 throughout the year 2019). The extraction of lexical content from the 60 selected medical charts of subjects attended to by the H&BD generated a 166-page Word document, which was processed using the NVivo program through axial categorization (Strauss and Corbin 2016).

Results

The medical records whose text was analyzed in this study had annotations from various specialties (only 27% from Group A and 40% from Group B had annotations from a single specialty)2. In no case was the record filled out by a general physician (in Colombia, individuals with a medical degree but without any specialization), and there were annotations from fellows in only two medical records. Table 1 contains the specialties and subspecialties that made annotations in the analyzed medical records. The number of specialties is greater than the n analyzed in this study because a single record contained annotations from multiple specialties. The specialties that most frequently made annotations were critical care, internal medicine, and palliative care (67% of annotations in Group A and 73% of annotations in Group B), which attend to patients with chronic illnesses and/or catastrophic injuries, often in end-of-life contexts. These situations give rise to difficult cases and motivate the request for support from the H&BD.

Table 1.

Specialties and subspecialties that made annotations in the patient’s medical record

Group A Group B
Internal medicine 14
Palliative care 11 16
Critical care and intensive care 8 22
Surgery 4 1
Geriatrics 4 3
Psychiatry 2 1
Pediatric gastroenterology* 1
Infectious diseases 1
Nephrology 1
Pulmonology 1
Emergency medicine 1 1
Therapeutic support 1
Anesthesiology 1
Surgical oncology* 1
Hematology 1
Hepatology 1
Neurosurgery 2
Oncology 1
Pediatrics 1
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Those marked with * are considered fellows in Colombia

Regarding the analysis of the text extracted from the medical records, this yielded emergent categories belonging to the initial lexical content related to bioethics, which are illustrated in Fig. 1.

Fig. 1.

Fig. 1

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Hierarchical organization of category analysis

When reviewing the lexical content related to bioethics in the medical charts, two language uses were observed: first, the use of technical bioethical language; and second, language referring to bioethical knowledge, albeit tangentially. The proportion of lexical content using tangential language is similar in both groups of medical charts (Groups A and B, see Fig. 2). Regarding these initial findings, several aspects can be mentioned. The first is related to the presence of lexical content related to bioethics from the early years of H&BD’s operation. The establishment of H&BD found a suitable space for its development within the hospital, which is directly linked to the institutional philosophy of person-centered care, involving processes focused on humane medical care in conjunction with ethics committees. The tangential language of bioethics observed in physicians’ verbal statements would suggest an impact of these strategies on professionals within our institution. Despite the similar tangential presence of bioethics in verbal statements in both groups (Groups A and B; see Fig. 2), the qualitative analysis allowed us to observe significant differences.

Fig. 2.

Fig. 2

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Technical bioethical content versus tangential

The verbal statements from recent medical records (Group B) exhibit a greater use of technical bioethical language, featuring expressions like therapeutic effort limitation, futility, beneficence, and respect for autonomy. The increased presence of these expressions in the technical language of physicians in Group B could be related to a positive impact of H&BD’s bioethics consultations, particularly in the clinical departments that H&BD supports and from which it receives more consultation requests (critical care, internal medicine, and palliative care; see Table 1). These requests (which go beyond simply making a note in the patient’s medical record, involving ongoing case management with constant communication with the requester of the bioethics consultation and occasional multidisciplinary meetings to discuss the case) allow H&BD to engage in an ongoing educational process. In addition to the hospital’s person-centered humanization strategies, this process cultivates the theoretical foundation of bioethics through its practice. This educational role, not just an advisory one, of the ethical consultation has been described by other authors as well (Cummins et al. 2023).

In the results, there is a strong presence of expressions from the technical language of bioethics that refer to end-of-life scenarios, including the following: limitation of therapeutic effort, euthanasia, and dignified death, without being limited to specialties related to these scenarios, such as palliative care. End-of-life decision-making does not always involve palliative care professionals, and, on the other hand, the processes of death are not exclusive to the care provided by this specialty. Figure 3 illustrates this presence in verbal statements (the size of the words is directly related to the frequency of these expressions appearing in the medical charts, only the most frequent words are illustrated). Other expressions of technical language were also found. These expressions, although less frequent (hence, not all visible in the word cloud of Fig. 3), are also of interest for this analysis. These include advance directives, respect for autonomy, shared decision-making, beneficence, and futility.

Fig. 3.

Fig. 3

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Word cloud of common technical language

The category of respect for autonomy pertains to the descriptions clinicians provide when inquiring about patients’ and their families’ wishes and desires, as well as addressing processes they have already carried out in the hospital, such as informing patients and their families about the procedures and interventions performed during hospitalization. Finally, shared decision-making, which guides the work of our department (Prieto et al. 2020; Charles et al. 1997; Elwyn et al. 2012), was also found in clinicians’ verbal statements. Through shared decision-making, the voice of each of the agents involved in the decision concerning an ill patient becomes visible (previously, in the paternalistic clinical model, only the doctors’ voice was evident). This generally involves the doctor, the patient, and their family. The various activities of H&BD consistently mention this procedure, which naturally takes place in every bioethics consultation and is further evident in practice as meetings with the different agents involved in the clinical encounter are frequently encouraged: the healthcare professional, the patient, and their family. It appears that the presence of technical language in clinicians’ verbal statements indicates the presence of declarative knowledge related to the realm of clinical bioethics.

Discussion

From Consultations to Education: Clinical Bioethics’ Impact on Latin American Healthcare Professionals

This study aimed to understand the impact of bioethical consultations on physicians who seek support from H&BD by analyzing medical records. The presence of technical bioethical language in the medical charts of physicians can be interpreted as an appropriation of bioethical knowledge which, due to its characteristics, strongly reflects the context of H&BD’s greater involvement: end-of-life scenarios. If medical records are recognized as a form of synthesis conducted by physicians, representing teamwork and containing verbal statements indicating thought processes suggestive of learning, this technical bioethical language can be understood as words that treating physicians have incorporated into their knowledge. This is evident through their lexical expressions, which have been reinforced and learned through the educational processes generated by H&BD during bioethics consultations, which are prevalent in end-of-life scenarios but not limited to them, as described in the results section. Verbal statements were found, indicating respect for patient autonomy, for example, when refusing treatment, often occurring through a process of shared decision-making and without the patient being in an end-of-life scenario.

Declarative knowledge is explained as a knowing what (Carroll 1993). The knowing what about clinical bioethics, that declarative knowledge present in the reviewed medical records, is linked to a praxis, a knowing how (procedural knowledge (Carroll 1993)) that, for the purpose at hand, involves the doing, the behaviors that are morally defensible. This seems to have been acquired in previous moments by the professionals who write the clinical reports; in other words, knowledge related to learnings that professionals have gained through the support provided by the department in response to bioethical consultations.

The correspondence between declarative knowledge (knowing what) and procedural knowledge (knowing how), meaning that what is said corresponds to what is done, has been described by various authors, including its specific description in relation to moral behavior (Nicolais et al. 2017). In other words, there is a relationship between knowing what is good and the duty, and actually doing that good, fulfilling that duty. The analysis of the findings in this study attempts to suggest a connection between this knowing what and knowing how within the realm of clinical bioethics, as follows: while there is uncertainty about whether there is congruence between knowing what and knowing how (here, knowing what is good and doing what is good in a clinical context), these doubts seem to stem from a lack of knowledge about that how. For example, in research processes, having the report isolated to the what, as studies on morality often remain isolated from behavior as they inquire about hypothetical issues regarding the choice of the best conduct, starting from the narratives of the subjects; which is not the case in this study.

In this research, and considering what has been stated, the verbal statements of the subjects can be seen as an endpoint, they are evidence of an exercise in synthesizing thought related to significant learning acquired in a clinical context that deals with the approach to a challenging case. In other words, these verbal statements are like the tip of an iceberg that reveals an entire process of education carried out by the department in the hospital through bioethics consultations, which culminates in the synthesis of thought reflected in the medical record of a patient.

For this study, the choice of the best course of action is a constant concern for those seeking the department’s support, as the intervention of H&BD is not policing in nature. In other words, there is a supportive process provided by H&BD that is requested when clinicians, patients, and their families experience moral distress, without this translating into an auditing approach. Within the interaction with the bioethicist, and given the characteristics that we propose and foster within the department—the bioethicist—not only encompassing that knowing what and knowing how related to morality but also a particular condition that accompanies this process of intervention and education from clinical bioethics: moral sensitivity (Prieto et al. 2020, 2022). This moral sensitivity, essentially, serves as a condition for being able to establish an empathetic relationship with the other who is undergoing a morally distressing experience.

The processes of requesting consultations, in the case of hospitalized patients from whom the clinical records were analyzed3, are entirely initiated by the physician and/or the patient’s treatment team. This situation, often accompanied by moral distress as mentioned earlier, generates a motivation to acquire that knowledge (meaningful learning), and whose declarative knowledge, accessible through the medical charts, reflects adherence to the department’s suggestions. Furthermore, this is supported by follow-up surveys conducted within the department as an improvement strategy, which indicate a compliance with their recommendations in 90.9% of the individuals who request consultations.

The presence of technical language from bioethics in the medical charts of physicians, under the contextual conditions highlighted here, can also be interpreted as a cultivation of morality, a cultivation of moral awareness. Language gives meaning to everything that exists; words determine actions and enable us to ascertain what should be and what should be done (practical reason); words (knowing what) are not separate from human action (knowing how); furthermore, language is an act in itself and creates realities (Camps 1976). In bioethics, the use of technical language acquired in an informal academic setting, such as the process of bioethics consultation, implies changes in how a physician approaches the reality and clinical facts of a patient. For instance, in cases of limitation of therapeutic effort, it involves recognizing that life is not an absolute value and that death is not a failure in the process of medical care, or that the care process for an ill person is not a matter solely involving the clinician’s decision, but a process of shared decision-making between the physician, the patient, and their family.

In this way, the intervention of the H&BD, with its educational effect, resignifies4, or in other words, re-elaborates those verbal statements, those narratives, as described by Franco A. Carnevale (2007) who suggests that, in the face of master narratives “that expresses as well as shapes dominant societal beliefs, values and norms” (Carnevale 2007, 5), such as the sanctity of life or the absolute value of life (Singer 1997); it gives space to counterstories, which are “narratives that contest the dominant ethos, giving voice to human experiences that have been displaced to the margins” (Carnevale 2007, 5), such as life as a good for human beings, but not as an absolute good (ethics of the quality of life (Singer 1997)).

In adults, novel experiences, such as the novelty (and significant complexity and moral stress) of a challenging case in clinical care, appear to be comparable to the process of all new learning, as is recounted with the emergence of moral consciousness in a child (Giampaolo and Camilla 2018). Explanations for the ontogenetic development of moral consciousness in individuals are described with a primacy of two of its tripartite components: emotions and behaviors5 (Giampaolo and Camilla 2018; Kochanska et al. 2005). If we consider this in the context of individuals who seek the department’s support in challenging situations, there is already a presence of behaviors and emotions that have led to a certain coping response from the individual to the difficult situation. The individual has not been able to intervene, and this has generated behaviors and emotions that motivate the search for help.

All of this takes place in the context of a high-tech hospital in a Latin American country, with the unique characteristic of this context that is worth highlighting and is related to the subjective perception of happiness (well-being6) which positively and deeply influences the process of bioethical consultations. In Latin America, there is something specific to this culture that seems to be related to the classification of countries in this southern part of the globe as happy)7. This is described by some as the Latin American paradox8 (Bericat and Acosta 2021; Rojas 2021), a paradox when contrasting this measurement with the country’s level of progress and its per capita income, meaning that higher per capita income and greater progress lead to greater happiness, and vice versa. Thus, the Latin American paradox arises from the question: how can a country with low per capita income, in the process of development, be among the happiest in the world?

The paradox, however, is a spurious correlation between the subjective perception of happiness and the country’s economic progress (Rojas 2021). What scientific studies of happiness assert is that the most important factor in the subjective perception of well-being is the selfless and genuine relationships between human beings, as well as the perception of work as a good and education as a path, not only to increase knowledge and skills for generating a better income but also knowledge and skills for people to have a more satisfying life (Rojas 2021).

The bioethical consultation, moreover, is not intended as a policing measure; rather, it becomes a calm encounter, a safe space to which individuals experiencing moral distress turn to learn how to choose the best course of action in a difficult clinical situation. These specific characteristics foster selfless and genuine relationships between the medical team and the bioethicists, which also contributes to an enhanced perception of subjective well-being. This facilitates aspects like empathy, often mentioned in different human interactions, but interpreted in a mechanistic manner, lacking the essence of “being present” (Rosenberg 2013) that should accompany it when it comes to truly being by the side of a vulnerable individual (here, not only the patient and their family but also the physician experiencing moral distress when facing a difficult case).

There is another issue to mention, specific to Latin culture, which seems to benefit the interaction with a vulnerable individual in challenging situations, as observed in bioethical consultations, and which can be framed in terms of the description of collectivism versus individualism and its implications for haptic communication, or in other words, touch. There are cultural differences between Latin Americans and Anglo-Europeans that are relevant to the topic at hand, particularly concerning their interactions with others. Latin Americans are described as highly collectivist (Andersen 2011), meaning there is physical closeness with others and a high degree of haptic communication. In contrast, cultures like European and Anglo-American are described as individualistic, which implies a greater emphasis on personal space and less haptic communication (Andersen 2011). These cultural differences can cause certain haptic expressions, common in Latin culture, to be perceived as invasive or offensive by cultures characterized as individualistic, such as Anglo-Americans (Albert and Ha 2004; Cohen 1987; Hall 1966).

Touch and verbal communication go hand in hand. The importance of considering the Latin context and haptic communication in a study like the present one is intended to highlight the complexity of communication processes, which are not limited to the exchange of lexical content in language. From various fields of knowledge, such as neuropsychology (Sacks 2008) and philosophy (Han 2014), it is demonstrated and argued how speech consists not only of words but also of expression (Han 2014; Sacks 2008). Language has a tactile dimension (Han 2014) that proves to be the most important when it comes to communicating something to someone, including touch. In this way, it is possible to think that the verbal statements recorded in the reviewed clinical histories reflect an encounter with the patient that includes verbal expressions accompanied by this tactile dimension and, due to the sensitivity of the topics and the cultural context in which the research was conducted, haptic communication may have been present. However, this is an assumption that, while it cannot be confirmed by this study, becomes evident in it and suggests the need for further study.

The mention of these cultural differences raises the question of the role of haptic communication and social proximity in human interactions. For instance, “touch throughout the world is the expression of interpersonal closeness” (Hertenstein and Weiss 2011, 352), “touch releases oxytocin...a chemical known to produce feelings of warmth, intimacy, and even love” (Hertenstein and Weiss 2011, 353), “communicate positively valenced warmth” (Hertenstein and Weiss 2011, 353). Therefore, haptic communication is central to empathetic communication. Touch, as described by Hertenstein and Weiss (2011), is something intrinsic to human social beings; it allows the expression of various emotions that are identified as keenly as those conveyed through facial expressions or spoken language. Moreover, touch is even more powerful than verbal or emotional language (Schanberg 2014). In the consultations carried out by H&BD, haptic communication is used to enhance the interaction with others. It provides a space of warmth and empathy, especially during moments of high emotional tension, which is common in situations of moral stress.

Conclusion

In conclusion, the latest medical charts (Group B) indicate an appropriation of bioethical knowledge within the clinical care groups. Through our study, we can recognize how our H&BD has had a positive impact on the bioethical and moral education of our healthcare professionals, who increasingly have more bioethical (moral) tools to guide their actions. The debate about whether we are born moral or become moral dates back several millennia and remains relevant today. While this study cannot provide a definitive stance on this issue, it is possible to point out the significant effect that experiences and educational processes have on the moral agent.

The work of the H&BD consistently emphasizes that we are human beings caring for other human beings. If we add that there is a significant learning process for those seeking bioethical consultation, we can conclude that the impact of bioethical consultations on the physicians who seek this support is positive. It not only indicates that bioethical knowledge is cultivated in professionals but also nurtures their sensitivity and moral awareness. Recognizing the context in which this study takes place, it is reasonable to assume that these encounters with patients involve a tactile dimension of language on the part of the physician, allowing for an empathetic encounter, a claim that requires further studies for confirmation.

Acknowledgements

We express our gratitude to the Fundación Santa Fe de Bogotá University Hospital for making the development of this study possible. This research had no sources of funding.

Author Contribution

NR-S: substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data;  drafting the manuscript and revising it critically for important intellectual content;  final approval of the version to be published.  PP-M:  substantial contributions to conception and design; revising the manuscript critically for important intellectual content;  final approval of the version to be published.

Declarations

Ethics Approval and Consent to Participate

This study was approved by the Institutional Ethics Committee (IRB) under official letter CCEI-12317-2020 and by the Research Ethics Committee of the hospital, being a secondary data analysis study, it was exempt from informed consent.

Competing Interests

The authors declare no competing interests.

Footnotes

1

The italics are ours. There exists a history of imitative relationships between Euro-North America and Latin America, where Latin America follows Euro-North American proposals as mere application of these to its context, suggesting an abstract universalism of these proposals that assumes their application in any context (de Zubiría-Samper 2021). This kind of attitude does not recognize the influence of the context, cultural variations, and the dynamism of society (“it suppresses differences and makes the sociocultural context's relevance in mediating knowledge, discourses, and practices invisible” (de Zubiría-Samper 2021, 70).

2

An individual analysis of the doctors was not conducted due to the comprehensive patient record’s mixture between clinical care provided by individual subjects and care delivered by groups of professionals. In other words, there are annotations in medical records made by a single professional, while others, even though attributed to an individual, are the result of discussions among a group of professionals and graduates and trainees who discuss the case. On the other hand, specialization-based discrimination would also introduce bias, as the described specialties involve rotations of students training for other specializations. This prevents establishing a direct relationship between the indicated specialty and the presence or absence of technical language.

3

We also have consultations carried out by outpatient patients, as well as other forms of intervention by the H&BD such as talks, workshops, case reviews, which are not analyzed here.

4

“On many occasions, for instance, in the face of requests for futile treatment, family members making these demands hold a perception of these treatments as beneficial for the patient, overlooking all that clinically involves administering a treatment marked as futile by the professional. In such cases, the bioethicist explains—educates—the family members about the negative implications of the treatment that seems beneficial on the surface. In other words, the bioethicist resignifies the family members’ mistaken perception of the treatment” (Prieto et al. 2020, 203-204).

5

The third one is cognition (Giampaolo and Camilla 2018; Kochanska et al. 2005).

6

The author cited in this paper suggests using happiness and well-being as synonyms, although he points out some differences between them (Rojas 2021).

7

The Happy Planet Index (https://happyplanetindex.org/) assesses the subjective perception of well-being. Colombia is consistently within the top 10 and in 2019, it ranked third.

8

The relationship established between per capita income and progress with happiness is strong and appears justified in low-income countries like Colombia. High levels of poverty in communities create conditions of vulnerability that lead to situations of risk (Ortega Londoño et al. 2019), contexts of poor mental and physical health, and the risk of human rights violations. All of these factors affect well-being or happiness (Graham and Felton 2005).

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