Points for organizing an ethics committee
Determining structure is first step
Editor's note: Medical Ethics Advisor is beginning an occasional series with articles designed to help provide useful information in the organizing and administration of ethics committees.
When it comes to forming an ethics committee, whether a hospital is large or small, long-term thinking and planning generally is the key to success, it would seem. And while refinements can always be made, two challenges — training and recruiting — always seem to be present, according to Felicia Cohn, PhD, director of Medical Ethics at the University of California-Irvine School of Medicine.
"The first step is choosing the infrastructure and reporting functions you want your committee to have, and who will be responsible and accountable for the committee's work," Cohn says. "And that's going to vary depending on the kind of institution you have."
Three options noted
First things first. Among the three options noted by Cohn are the following informally designated models: medical staff; administrative committee; and independent, with the latter probably being the rarest example utilized, she says.
"If you go and make it a medical staff committee, it's going to serve at the pleasure of the medical staff, so the medical staff president is going to have the ultimate authority over appointments and functions, and it's going to primarily address issues that the medical staff deals with," Cohn says. "So, it's going to be very clinically focused and deal mostly with bedside issues."
Other structure options
An ethics committee that is "constituted by the executive group" likely will have a "broader charge and may include not just clinical ethics but also organizational ethics," Cohn says.
The third option, which she describes as somewhat "free-floating," might be selected as the organizational model for the ethics committee if, for example, one hospital fits into a larger, overall health care system. It also is the organizational model likely to have the greatest level of independence from outside influences.
"So, for an institution that's concerned about biases from their executive level, or if there are issues external to the institution that need to be addressed, and they want to avoid interference from the institution, [this model] might be the way to go," Cohn says.
Recruiting is a challenge
One of the greatest challenges in organizing a committee is recruiting for it. In Cohn's experience, many people within a hospital or healthcare system may have interest in serving on the ethics committee. Unfortunately, some of those who express interest will not have the necessary training to serve, despite their "good intentions."
"Ideally, there would be at least one person with an academic background in bioethics and experience doing clinical ethics consultation, who can, if not chair the committee, administer the committee," says Cohn, who serves on the ethics committee of the University of California, Irvine, in addition to teaching ethics to medical students and residents.
If a medical staff model is selected, then it should be a goal of the organizing committee to recruit from all the clinical specialties – from primary care physicians to surgeons to rehab. But the list of specialty areas that should have representation does not end there; it should include other specialty areas such as nurses, social workers and respiratory therapists.
Risk managers are also helpful to have on such committees, but they may be constrained by too many other responsibilities demanding their time. One thing Cohn stresses is the enormous commitment that serving on an ethics committee requires of its members.
An ethics committee should also have one or more attorneys serving as members, but she says, "you need to find the right kind of attorney" — for example, one who is not just concerned with the letter of the law, but also is "more open to ethics analysis."
That could be the hospital's legal counsel, or it could be a member of the community.
Training not just knowledge-based
In addition to recruiting, training of ethics committee members is one of the fundamental challenges, according to Cohn.
"The hardest part about the training is it's not just . . . knowledge," she says. "It's skills and attitudes, and those are much harder to teach than knowledge. So, it's like medical education in a sense — it needs to be as much an apprenticeship as a class. [Members] need to observe consultations, learn to work with families and clinicians who are struggling with ethical issues and questions."
With healthcare professionals always being pushed for time, it's difficult to get them together for events such as weekend seminars. But such options are available, as are professionals who train ethics committee members who will come to a particular institution to conduct the training.
Another option is training with members of established ethics committees at other institutions.
"So far, I haven't found any resistance to sharing consultation strategies and background informational education," Cohn says.
Next month, Medical Ethics Advisor will feature an article focusing on the different methods available for recruiting for ethics committees.
Source
For more information, contact:
- Felicia Cohn, PhD, director of Medical Ethics, University of California, Irvine, School of Medicine. E-mail: [email protected].
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