Ethicists create their own constitution’
Reception from providers is positive
Members of the joint task force responsible for creating standards for bioethics professionals and ethics committees were given an onus more than a year ago when they were asked to create a set of ethical standards for all providers in the health care community. But the drafters of the document which is still four months shy of completion in effect have drafted the "constitution" of the bioethics community. And much to the relief of the task force, the reception from health care providers involved in ethical issues is one of gratitude and respect.
A draft of the Standards for Bioethics Consulta-tion was presented formally at the joint meeting of three medical ethics-related organizations last month in Baltimore. A final version will be made available to members of the organizations in late February 1998. Many of the comments and suggestions from members who attended the presentation will be incorporated into the final version, says Mark Aulisio, PhD, research associate at the Center for Medical Ethics at the University of Pittsburgh Medical Center and executive director of the task force.
Three core competency areas were defined in the draft and deemed necessary for individual ethics consultants or ethics committees. The three competencies are skill levels, knowledge, and character. Although some ethicists believe the standards need further revisions, there is a great deal of enthusiasm for them as well.
"I do believe there is a level of accountability that is espoused in the standards, and I’m finding them useful in educating hospitals in my system. I’ve been sending copies [of the draft standards] to the committee chair in each of my system’s hospitals," says Thomas May, director of the Clinical Ethics Center at Memorial Medical Center in Springfield, IL.
Three main areas will affect you
Three areas of the standards where much of the discussion centered at the presentation are particularly important for hospital ethics committees. Many of the concerns and suggestions expressed during the presentation will be incorporated into the final version of the standards, adds Aulisio. Those areas are:
1. Twelve skill areas with individuals or at least one team or committee member having advanced knowledge and experience.
The task force realized that not everyone has advanced knowledge or experience in all areas of ethics, so it suggested that in certain areas, at least one member should have expertise, notes Aulisio. At the same time, the task force recommended a minimum level of knowledge for each committee member. All members of the ethics committee, for example, should have basic knowledge and understanding of several skills or abilities, including:
identifying the nature of the value uncertainty or conflict that underlies the need for consultation;
analyzing the value uncertainty or conflict;
facilitating formal and informal meet- ings by identifying the key decision makers and concerned parties and involving them in discussion;
represent the views of various parties to others.
2. Accountability and evaluations should help ethics committees by serving as an educational and continuous quality improvement process.
The task force believes that quality improvement is vital in ethics consultation. Therefore, aside from the core competencies, evaluating and modifying ethics consultations is necessary to improve the quality of future consultations, the standards suggest.
Start thinking about outcomes
The task force suggests three reasons evaluations are necessary. First, ethics consultations are rarely formally evaluated, despite the focus on quality assurance and development of performance criteria in other areas of health care. Second, there is a lack of empirical data regarding which methods for ethics consultation whether it be individual, team, or committee work best in achieving the goals of ethics consultations. Third, ethical issues demanding attention will change and evolve in the coming years, and there is no assurance that what is required for quality consultations now will continue to serve well in the future.
3. Health care institutions must be responsible to those who use ethical consultation services by providing support to those who offer the service.
The concluding section of the task force’s draft version lists three areas where support is needed in the institutional setting:
Institutions should provide the resources for those who offer ethics consultation in their institution to ensure that they have the competencies to perform consultation appropriate to the size of the institution, including providing time and tuition for continuing education and access to core bioethics resources, such as texts, journals, and on-line services;
Institutions should ensure that those who offer ethics consultations are given adequate time and compensation to conduct it properly;
Institutions should seek to foster a climate in which those offering ethics consultation services can carry out their work with integrity, such as a climate free of concerns about job security, reprisals, and undue political pressure.
Jan. 1 is the deadline
Comments and suggestions regarding the standards will be accepted until Jan. 1, Aulisio notes. Comments and suggestions can be e-mailed to the task force office or written and sent in. (See source box above for names and addresses.)
The comments then will be forwarded to members of the task force before a final version of the document is completed in late February 1998. Medical Ethics Advisor will continue to update subscribers on the task force’s progress as well as provide an analysis of the final document.
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