Harvard's Committee seeks to give voice to all
CEC developed as resource for various committee
Seeking to give a voice to the patients served by its various institutions, Harvard has established the Harvard Community Ethics Committee with one distinct mission: To contribute to ethical decision-making. Now, those decisions are being made with input from members of the community.
There are three areas in which hospital ethics committees typically contribute to an institution: policy development; ethics consultation; and education. Currently, Harvard's CEC is focused on policy.
"The reason we established the committee is because we wanted to get a better sense of what some of the community views and values were on a number of clinical, ethical issues," says Christine Mitchell, director, Office of Ethics, Children's Hospital Boston, and associate director, Clinical Ethics, Harvard Medical School, Division of Medical Ethics.
The CEC has been operating for two years, and functions under the auspices of the Harvard Ethics Leadership Group.
In a general introduction to the CEC, members write: "The need for such a consultative group has been evident for a long time, since individuals currently serving as members on hospital ethics committees are not able to be broadly representative of multiple communities."
Members are from diverse backgrounds
The goal for the 15 members of the CEC was diversity, and the Harvard leadership cast a wide net for prospective members throughout the community — particularly in business and church groups — to recruit members.
There is diversity in the CEC as to "socio-economic status, religious affiliations, cultural and language groups, and educational background," the members write in an introduction to their committee.
Nine women and six men comprise the group. "Some of us have advanced degrees and some of us have high school diplomas. Among us are a high school administrator and two high school teachers; a rabbi and a minister of a large downtown Boston church; a manager of a residential facility for disabled individuals and parents with disabled children. Two of us have disabilities and two of us are retired, one from a large Boston law firm. We are students and writers and small business owners and volunteers.
"We volunteer at a local rape crisis center, on an Institutional Review Board, in health care facilities. We belong to eight different religious traditions, including atheism, and we speak seven different languages," according to the introduction.
Mitchell notes that the CEC includes a high school student, as well as a college student, among its members.
"Obviously, we can't get children, can't get people who are so handicapped that they are not competent, but we have gone out of our way to make sure that we had [members who had been] hospitalized for many surgeries, had chronic health care problems, but also people from a variety of different backgrounds," Mitchell says.
All of the members attended the Harvard Bioethics Course in June 2007, which was the genesis of the CEC. The committee is chaired by Carol L. Powers, JD, who also continues to serve as a community member on the regular ethics committee of the Children's Hospital, which she has done for several years.
Her beginning on that committee is rooted in her own experience with an infant son, who spent nine months in the intensive care unit at Children's after he was born with physical anomalies," and later died.
"It was probably the worst case kind of thing in that we faced almost every ethical dilemma along the way," says Powers.
Ultimately, Powers completed a fellowship with the Division of Medical Ethics at Harvard Medical School, and her project for the fellowship with developing the CEC.
"We were allowed to exist under the auspices of the Harvard Ethics Leadership Group," she says.
Harvard has seven teaching hospitals, and all of them have their own ethics committee and services.
In the world of physicians and nurses and instruments and devices that presumably prolong life, the voice of the typical community individual comes as a "very important stakeholder" in that the patients are the ones being served, because, health care, after all, is a service business, she says.
Physicians and nurses may become immune to the personalized nature of health care delivery — or the goal of health care delivery, she says.
"In other words, I think what happens is when you're in the medical community, you start looking at things very — I don't want to say this pejoratively — very skewed, in that medical interventions are always good, and if the technology is available, you should always use it — and that sort of bias," Powers tells Medical Ethics Advisor.
"The community, in many ways, brings a much more personalized view, which is: Who is suffering, and what are the cultural biases, and perceptions that sort of thing?" Powers says. "And that's why having that community voice is so important."
Although the committee has a broad vision for its mission, including the development of a web site that would serve as a forum for individuals and ethics committees across the country, currently the Harvard CEC is solely consulting to the various ethics committees on policy.
"We basically consult to them," Powers says. "In other words, a question kind of bubbles up that they would like to have the community voice speak to, and they then present a question — they being members or representatives from the hospital community, then present the question to us. And we go from there."
One of the first policy initiatives tackled by the CEC was one on cardiopulmonary resuscitation (CPR). Through a lengthy, involved process of surveys and research, the CEC developed a policy that would allow physicians to determine whether or not to administer CPR, which is "quite different" from the standard policy of asking patients when they are admitted to the hospital whether or not they would like to be resuscitated.
Another policy considered by the CEC was a policy regarding procuring organs using cardiac death criteria — not just brain death criteria, according to Mitchell.
"So, it's a transition from just using brain death to now also considering procuring organs in cardiac death when there are decisions to withdraw life support," Mitchell says.
That shift made it important "for us to get some sense of how parents, who weren't already involved completely in clinical, health provider-mindset, might think about this," she says.
"So, that's the kind of example we brought to a lay group to see, — "Did it make any difference to them to know the difference between brain death and cardiac death, for example. Does it make any difference if the donor is a child or adult, etc.?" Mitchell maintains that it can't be helped that health care providers who are working in a system "already know a lot of the nuances of these things."
"So, it's very hard to put yourself in the shoes of someone who doesn't have that knowledge, and to get a sense of what would be morally concerning to them," Mitchell says.
Seeking to give a voice to the patients served by its various institutions, Harvard has established the Harvard Community Ethics Committee with one distinct mission: To contribute to ethical decision-making. Now, those decisions are being made with input from members of the community.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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