Whose Trauma? Who’s Trauma Informed?
How a traumainformed ethics consultant could address this request in a way that acknowledges how ethics involvement in Maurice’s care could invite opportunities to provide TIC and TIEC to the patient as well as the medical team is explored.
Abstract
This case raises questions of what “trauma-informed care” (TIC) means to the medical team caring for Maurice and how they embrace a TIC approach. There are established principles of trauma-informed care (Substance Abuse and Mental Health Services Administration [SAMHSA] 2014). But as we’ve suggested before, “TIC principles like safety, trust, collaboration, or voice may look and feel different for individuals or groups depending on their own trauma histories, contexts, or needs. How to achieve these principles in practice will therefore often need to be situation-specific rather than one-size-fits-all” (Lanphier and Anani 2022b). For the medical team, what steps are they taking to minimize re-traumatization and enhance TIC principles like safety, leveling hierarchy, or attending to bias in their care? Moreover, how did they determine that the ethicist speaking with Maurice or Ramona is more likely to be triggering, or to conflict with TIC rather than such direct communication supporting TIC by fostering a sense of trust, collaboration, or empowerment? We might additionally worry that not formally assessing Maurice’s capacity, deferring to his sister, and potentially dismissing the preferences he conveys, fails to empower Maurice, or include his voice, running counter to the team’s embrace of TIC. This case reflects the reality that TIC is not standardly integrated into ethics consultation training or practice. It also demonstrates the potential for trauma-informed ethics consultation (TIEC) to support rather than detract from a team or unit’s trauma-informed approach. One commitment of trauma-informed care is that it ought to be integrated throughout an organization. This case shows why this should include a hospital’s ethics service. In our response, we primarily explore how a traumainformed ethics consultant could address this request in a way that acknowledges how ethics involvement in Maurice’s care could invite opportunities to provide TIC and TIEC to the patient as well as the medical team.