Development of a Hospital Ethics Committee: Lessons from Five Years of Case Consultations

1992 ◽  
Vol 1 (1) ◽  
pp. 41-50 ◽  
Author(s):  
William S. Andereck
Keyword(s):  
Community Hospital ◽  
Evaluation Model ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Consultation Process ◽  
Substituted Judgment ◽  
Competing Demands ◽  
Case Consultation ◽  
Hospital Ethics ◽  
Attending Physician

The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care. Most patients evaluated have been unable to clearly express their wishes concerning further treatments, highlighting the need for promoting advance directives. When resorting to substituted judgment, our committee has supported continued care in a majority of cases. Limitation of the consultation process to the attending physician has, in our experience, actually served to increase the credibility of the committee and has promoted acceptance of its recommendations. The committee's most useful function seems to be in assisting physicians and their patients in defining realistic goals and limitations of treatment. Within this context, the coming decade may find ethics committees concerned less with promoting the autonomous wishes of individual patients than with defining the limits of that autonomy against the competing demands of the larger society. Such a shift be approached with caution.

Invoking the Law in Ethics Consultation

1993 ◽  
Vol 2 (4) ◽  
pp. 457-467 ◽  
Author(s):  
Bethany Spielman
Keyword(s):  
Ethical Issues ◽  
Ethics Consultation ◽  
Ethics Committee ◽  
Legal Issues ◽  
University Hospital ◽  
Recent Book ◽  
Consultation Process ◽  
Legal Information ◽  
Case Consultation ◽  
Hospital Ethics

A request that an ethics committee or consultant analyze the ethical issues in a case, delineate ethical options, or make a recommendation need not automatically but often does elicit legal information. In a recent book in which ethics consultants described cases on which they had worked, almost all cited a legal case or statute that had shaped the consultation process. During a period of just a few months, case consultation done under the auspices of one university hospital ethics committee involved interpretation of statutes on living wills, durable powers of attorney, competency, confidentiality, guardianship, AIDS testing, and disability (personal observation). At another hospital, 30% of ethics consultations were thought to involve legal issues. Attorneys at a third hospital estimated that virtually every case involves legal issues. The notion that ethics consultation is an “amalgam” of medicine, ethics, interpersonal skills, and law is gaining currency. Ethics consultation has become a channel through which law enters the clinical setting.

Ethics Case Consultation in Primary Care: Contextual Challenges for Clinical Ethicists

2009 ◽  
Vol 18 (4) ◽  
pp. 397-405 ◽  
Author(s):  
ANNE SLOWTHER
Keyword(s):  
Primary Care ◽  
Clinical Ethics ◽  
Western Europe ◽  
Ethics Consultation ◽  
Ethics Committees ◽  
The United States ◽  
Health Maintenance Organizations ◽  
Ethics Committee ◽  
Health Maintenance ◽  
Case Consultation

The development of ethics case consultation over the past 30 years, initially in North America and recently in Western Europe, has primarily taken place in the secondary or tertiary healthcare settings. The predominant model for ethics consultation, in some countries overwhelmingly so, is a hospital-based clinical ethics committee. In the United States, accreditation boards suggest the ethics committee model as a way of meeting the ethics component of the accreditation requirement for payment by Health Maintenance Organizations (HMOs), and in some European countries, there are legislatory requirements or government recommendations for hospitals to have clinical ethics committees. There is no corresponding pressure for primary care services to have ethics committees or ethics consultants to advise clinicians, patients, and families on the difficult ethical decisions that arise in clinical practice.

scholarly journals Clinical ethics committees in nursing homes: what good can they do? Analysis of a single case consultation

2021 ◽  
pp. 096973302110032
Author(s):  
Morten Magelssen ◽  
Heidi Karlsen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Clinical Ethics ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Clinical Ethics Committee ◽  
Clinical Ethics Committees ◽  
Home Context ◽  
Case Consultation ◽  
Research Interviews

Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer to this question must begin with an understanding of how a clinical ethics committee might be beneficial in a nursing home context – to patients, next of kin, professionals, managers, and the institution. With the present article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to stakeholders in a nursing home context? We describe in depth a clinical ethics committee case consultation deemed successful by stakeholders, then reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics committee members and interviewed stakeholders consented to study participation, and also gave specific approval for the publication of the present article. Findings/results: Six different roles played by the clinical ethics committee in the case consultation are described: analyst, advisor, support, moderator, builder of consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research is needed to examine whether clinical ethics committees might be suitable as ethics support structures in nursing homes and community care.

The State of Hospice Ethics Committees and the Social Work Role

2002 ◽  
Vol 45 (3) ◽  
pp. 261-275 ◽  
Author(s):  
Ellen L. Csikai
Keyword(s):  
Social Work ◽  
Social Workers ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Work Participation ◽  
Role Expectations ◽  
The Social ◽  
Case Consultation ◽  
Main Activity ◽  
Activity Areas

This study found that in six states, most hospices (73 percent) had access to some type of ethics committee; however, less than 1/3 maintain a hospice-specific ethics committee. Social workers, although integral to the hospice team, were only members of about one-half of the hospice committees. Further, the study examined social workers' current participation and role expectations of social workers and committee chairs for social work participation. Both groups viewed that social workers were important contributors and expected higher participation in all the three main activity areas—case consultation, policy, and education—than currently took place. As the particular skills and values of social work parallel both the purpose of ethics committees and hospice philosophy, and as these data suggest, opportunity exists for social workers to take on a greater role on hospice ethics committee and may be an important resource in the formation of such committees.

Hospital Ethics Committees in Paris

2000 ◽  
Vol 9 (3) ◽  
pp. 424-428 ◽  
Author(s):  
Jean-Christophe Mino
Keyword(s):  
Research Ethics ◽  
National Level ◽  
Life Sciences ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Institutional Form ◽  
Permanent Commission ◽  
Hospital Ethics Committees ◽  
The World ◽  
Hospital Ethics

Even if the term bioethics is used all over the world, its meanings are multiple and different, especially between American and European countries, depending on local cultural and medical contexts. These differences concern the issues discussed or the institutional form bioethics takes. In France, bioethics was used from the end of the 1970s and focused on research ethics and issues at the beginning of life. At the national level, a permanent commission, the “national consultative ethics committee on life sciences and health” (Comité Consultatif National d'Ethique, CCNE) was created by President François Mitterrand in 1983. Its recommendations dealt essentially with procreative medicine and biomedical research ethics.

Multiculturalism, Medicine, and the Limits of Autonomy: The Practice of Female Circumcision

1994 ◽  
Vol 3 (3) ◽  
pp. 431-441 ◽  
Author(s):  
Robert L. Schwartz ◽  
David Johnson ◽  
Nan Burke
Keyword(s):  
Female Circumcision ◽  
Ethics Committees ◽  
The United States ◽  
Ethics Committee ◽  
Horn Of Africa ◽  
The Past ◽  
Male Power ◽  
The World ◽  
Committee Decision Making ◽  
Hospital Ethics

Television pictures of starvation and depredation are not the only way that famine and political instability in the horn of Africa have affected the United States. Many people from that region of the world are seeking political or economic refuge here, and they are exposing us to a culture that is in some ways — most notably, in the practice of female circumcision – so radically different from the prevailing American cultures that we have been stunned. They are also forcing hospital ethics committees to face issues that cannot be resolved by the facile application of the settled principles that have guided those institutions for the past several years. Autonomy and multiculturalism, long the foundations of most ethics committee decision making, have started to give way to a list of formally articulated rights and wrongs – perhaps to a restatement and adoption of rules said to be based in natural law. Female circumcision, argues one newspaper letter writer, “is just a sickening display of male power disguised as legitimate dogma.

Barriers and facilitators to consulting hospital clinical ethics committees

2011 ◽  
Vol 18 (6) ◽  
pp. 767-780 ◽  
Author(s):  
Alice Gaudine ◽  
Marianne Lamb ◽  
Sandra M LeFort ◽  
Linda Thorne
Keyword(s):  
Clinical Ethics ◽  
Nurse Managers ◽  
Ethics Committees ◽  
Structured Interview ◽  
Ethics Committee ◽  
Barriers And Facilitators ◽  
Clinical Ethics Committees ◽  
Interview Guide ◽  
Nurses And Physicians ◽  
Hospital Ethics

Hospitals in many countries have had clinical ethics committees for over 20 years. Despite this, there has been little research to evaluate these committees and growing evidence that they are underutilized. To address this gap, we investigated the question ‘What are the barriers and facilitators nurses and physicians perceive in consulting their hospital ethics committee?’ Thirty-four nurses, 10 nurse managers and 31 physicians working at four Canadian hospitals were interviewed using a semi-structured interview guide as part of a larger investigation. We used content analysis of the interview data related to barriers and facilitators to use of hospital ethics committees to identify nine categories of barriers and nine categories of facilitators. These categories as well as their subcategories are discussed and those specific to nurses or physicians are identified. The need to increase health professionals' use of clinical ethics committees through reducing barriers and maximizing facilitators is discussed.

scholarly journals Hyperkalaemia prevalence, recurrence and treatment in patients on haemodialysis in China: protocol for a prospective multicentre cohort study (PRECEDE-K)

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055770
Author(s):  
Zhaohui Ni ◽  
Haijiao Jin ◽  
Renhua Lu ◽  
Li Zuo ◽  
Weimin Yu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Serum Potassium ◽  
Blood Gas Analysis ◽  
Ethics Committees ◽  
Good Clinical Practice ◽  
Ethics Committee ◽  
Gas Analysis ◽  
Electrolyte Imbalance ◽  
Hospital Ethics

IntroductionHyperkalaemia (HK) is a potentially life-threatening electrolyte imbalance associated with several adverse clinical outcomes and is common in patients with kidney failure. However, there is no evidence on the occurrence, recurrence and treatment of HK in patients on haemodialysis (HD) in China.Methods and analysisThe HK Prevalence, Recurrence, and Treatment in Haemodialysis Study is a prospective, multicentre, observational, cohort study being conducted across 15–18 sites in China. Approximately 600 patients with end-stage kidney disease on HD are anticipated to be enrolled and will be followed up for 24 weeks. Patients will be in the long interdialytic interval (LIDI) at enrolment and will receive follow-up care every 4 weeks in LIDI for pre-dialysis and post-dialysis (at enrolment only) serum potassium measurements. To obtain pre-dialysis serum potassium levels in the short interdialytic interval (SIDI), a follow-up visit will be performed in the SIDI during the first week. Information on concomitant medications, blood gas analysis and biochemistry measurements will be obtained at enrolment and at each follow-up visit. The primary endpoint will be the proportion of patients experiencing HK (defined as serum potassium level >5.0 mmol/L) at the study enrolment or during the 24-week follow-up. The key secondary endpoint will be the proportion of patients experiencing HK recurrence (defined as any HK event after the first HK event) within 1–6 months (if applicable) during the 24-week follow-up, including enrolment assessment.Ethics and disseminationThis study has been approved by Shanghai Jiaotong University School of Medicine, Renji Hospital Ethics Committee (2020-040). Other participating subcentres must also obtain ethics committee approval prior to the start of the study. The Good Clinical Practice regulations shall be strictly followed during the test implementation. Amendments to the protocol will be reviewed by the ethics committees. Written informed consent will be obtained from all participants before collection of any patient data and patient information. The findings of this study will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberClinicalTrials.gov Registry (NCT04799067).

Successes and Failures of Hospital Ethics Committees: A National Survey of Ethics Committee Chairs

2002 ◽  
Vol 11 (1) ◽  
pp. 87-93 ◽  
Author(s):  
GLENN McGEE ◽  
JOSHUA P. SPANOGLE ◽  
ARTHUR L. CAPLAN ◽  
DINA PENNY ◽  
DAVID A. ASCH
Keyword(s):  
National Survey ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Joint Commission ◽  
Healthcare Ethics ◽  
Healthcare Organizations ◽  
Hospital Ethics Committees ◽  
Healthcare Ethics Committee ◽  
Hospital Ethics ◽  
Successes And Failures

In 1992, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) passed a mandate that all its approved hospitals put in place a means for addressing ethical concerns.Although the particular process the hospital uses to address such concerns—ethics consultant, ethics forum, ethics committee—may vary, the hospital or healthcare ethics committee (HEC) is used most often. In a companion study to that reported here, we found that in 1998 over 90% of U.S. hospitals had ethics committees, compared to just 1% in 1983, and that many have some and a few have sweeping clinical powers in hospitals.

A French Perspective on Hospital Ethics Committees

2008 ◽  
Vol 17 (3) ◽  
pp. 300-307 ◽  
Author(s):  
JEAN-CHRISTOPHE MINO ◽  
LAURE COPEL ◽  
JEAN-MICHEL ZUCKER
Keyword(s):  
Cancer Treatment ◽  
Cultural Context ◽  
Ethics Committees ◽  
Ethics Committee ◽  
Research Centre ◽  
Political Transformations ◽  
Hospital Ethics Committees ◽  
New Models ◽  
Hospital Ethics

In this article we highlight the main points of the development of bioethics and ethics committees in France. We argue that the French cultural context of medicine and its current political transformations favor new models of hospital ethics committee and we provide an example of such a model developed at Paris's Institut Curie, the oldest French cancer treatment and research centre.

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