Understanding the role of ethics and bioethics committees

Most if not all healthcare organizations have an ethics or bioethics committee. In fact, since 1992, a condition of accreditation by The Joint Commission includes having a mechanism to resolve ethical dilemmas in patient care. However, the details of that mechanism are left to the discretion of each organization. The requirements were driven by a number of patient situations that involved some lack of clarity between patient and family wishes, expectations for treatment, the provider’s prognosis, and/or the patient’s treatment plan. The precedents set by each one of these cases prompted healthcare organizations to establish and maintain processes that support patient rights in the most ethical manner across all treatment, services, and business practices (McCabe, 2015).

Despite the presence of clear guidelines for ethics committees, these working groups vary considerably across institutions. There are varying perceptions of the right composition and number of members, their amount of preparation, the scope of each member’s role, and the quality of the work expected. It is common to see ethics committees developed without any formal plan, which can easily lead to unfilled expectations, inactivity, and a perception by the organization that the committee is not a valued resource (McCabe, 2015).

One large misperception of ethics committees lies in their function. Contrary to popular belief, ethics committees are not in place to tell clients, caregivers, or colleagues what to do. The traditional role of an ethics committee was to explore the clinical nuances of a particular situation and make sure the wishes of the patient were acknowledged specific to end-of-life decisions, while recognizing their right to refuse care, treatment, and services in accordance with all laws and regulations. In recent years, ethics committees affiliated with academic institutions and large healthcare systems have expanded their traditional functions to become more comprehensive ethics programs. There has been considerable expansion of how ethics committees are viewed, at times providing consultations in response to nonclinical ethics questions, identifying and remedying systems-level factors that induce or exacerbate ethical problems and/or impede their resolution, and promoting a positive ethics culture throughout the institution. A number of organizations now use the terminology “integrating ethics throughout the healthcare institution from the bedside to the boardroom” (University of Washington, 2013).

References:

McCabe, M. (2015). Reenergizing the hospital ethics committee: An opportunity for nursing. Journal of Hospice and Palliative Nursing, 17(6), 480–487.

University of Washington School of Medicine. (2013). Ethics committees, programs and consultation. Ethics in Medicine. Retrieved from https://depts.washington.edu/bioethx/topics/ethics.html.

Editor’s note: This article is an excerpt from The Essential Guide to Interprofessional Ethics in Healthcare Case Management by Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP.