The Maryland Healthcare Ethics Committee Network
Ethics Committee Functions
Ethics committees generally focus on three main functions:
Ethics consultation. The American Society for Bioethics and Humanities’ (ASBH, 2011) Core Competencies for Healthcare Ethics Consultation defines ethics consultation as “a set of services provided by an individual or a group in response to questions from patients, families, surrogates, health care professionals, or other involved parties who seek to resolve uncertainty or conflict regarding value-laden concerns that emerge in health care.” A distinction is made between “case consultations” [involving an identified patient for whom one or more recommendations is made by the ethics consultant(s)] and “non-case consultations” (basically, all other consultations). The Core Competencies document is available for purchase at http://www.asbh.org/. It is also summarized in the article, “Health care ethics consultation: An update on core competencies and emerging standards,” published in the American Journal of Bioethics (Tarzian & the ASBH Core Competencies Update Task Force, 2013, 13(2), 3-13). Also, review this list of Pearls and Pitfalls of Ethics Consultation, drafted by ASBH’s Clinical Ethics Consultation Affairs (CECA) Committee in 2011.
Ethics education. Many ethics committees engage in activities to educate others, both formally and informally. Informal education occurs during ethics consultations (i.e., explaining ethical concepts and issues to those involved in the consult) and other interactions with staff or family members. Formal education can include giving ethics lectures, sponsoring conferences, orienting new staff to ethics, or educating staff and family members about the ethics committee’s services. Ethics committees also must educate their own members. ASBH’s Improving Competence in Clinical Ethics Consultation: An Education Guide is a useful resource for identifying ethics knowledge content and ways to educate ethics committee members or staff.
Policy development. Policies are generally considered to be any governing principle, plan or course of action that an institution has adopted. Protocols are the means to implement the policies. Ethics committees traditionally weigh in on developing, reviewing, and revising policies that impact ethical decision-making in their organization. Examples of topics that ethics committees have addressed in policies include Do Not Attempt Resuscitation (DNAR, or “Allow Natural Death”) orders, artificial nutrition and hydration, informed consent, surrogate decision making, guardianship, determination of decision-making capacity, do not hospitalize orders, and advance directives. In addition to guiding health care providers, policies help advise patients/residents and family members prior to admission to help them make a more informed decision and to seek alternative care if the facility cannot accommodate their treatment preferences. For example, currently in Maryland, as stipulated in Maryland’s Health Care Decisions Act, if two physicians certify that cardio-pulmonary resuscitation attempts would be medically ineffective for a dying patient, they can write a DNAR order and inform the patient or family about everything that will be done to care for the patient, explaining that CPR attempts will not be attempted because they would not be appropriate or effective for a person whose death is imminent and unavoidable. Formalizing this in an institutional policy promotes transparency and increases the likelihood that “like cases are treated alike.” Read more about how one Maryland hospital did this in MHECN’s Winter 2014 newsletter »