Ethics committees face many challenges when it comes to recruiting new members. Some people volunteer for the role, but later have to discontinue participating because they lack the time. Others want to serve on the ethics committee, but they lack time — or expertise.
“To have a wide array of perspectives, it’s important to have enough people on the committee — and also to have enough people at each meeting to meet the level of rigor needed to provide ethical guidance for issues requiring committee discussion,” says Ian Wolfe, PhD, MA, RN, HEC-C, senior clinical ethicist at Children’s Minnesota.
For some members, serving on the ethics committee is one of the expectations for their role. Other staff have a harder time working it into their scheduled work time, such as ICU nurses and physicians. “For some, we can work with leadership to either accommodate or find compensation for them if they join us on their days off,” Wolfe says.
Some members attend every meeting; others have time constraints and attend when possible. A general interest in ethics is all that is required. The committee leadership looks to ensure a wide variety of perspectives. “Sometimes, a lack of formal education can be good, as it providers a different lens,” Wolfe offers. The committee does allow some time for education, including training in ethical discourse. “Ethical discourse can be intimidating for those not familiar with this type of debate, even when you have excellent ground rules and facilitation,” Wolfe admits.
After staff participate in an ethics consult, or interact with an ethicist, it sometimes sparks interest in joining the committee. Some joined after a difficult case during which they were struggling with ethical dilemmas, and the ethics consult helped them see the case in a different light.
The ethics committee also offers incentives for members, such as conference attendance. “This is good for both recruitment and furthering education of the committee,” Wolfe says. Recently, the Children’s Minnesota ethics committee leadership has focused more on organizationwide development of guidance statements and policies. “This has made the impact of being on the committee more visible,” Wolfe reports.
Houston Methodist Hospital’s bioethics committee places high importance on diverse membership, especially in terms of interdisciplinary diversity. The committee includes nurses, physicians, administrators, chaplains, social workers, and others. There is a combination of professional ethicists and individuals with varying degrees of ethics expertise and an overall interest in the field.
“Part of recruitment for the committee is just being open and attentive to people who seem to be attuned to ethics issues,” says Trevor M. Bibler, PhD, director of Methodist’s clinical ethics consultation services. Bibler also is an assistant professor of Medicine at the Center for Medical Ethics and Health Policy at Baylor College of Medicine. The committee includes about 45 members, 25 to 30 of whom attend each meeting. Recently, the committee invited a bedside nurse to become a member, because the nurse had shown keen interest in the ethical issues that arose during an ethics consult. New members are not expected to be engaged in nuanced ethical analysis on day one.
“We have a subgroup of people who are professionals and can dig in deeper to the ethical issues, who have put in a whole lot of time and effort, and are responsible for the inner workings of the committee,” Bibler says.
There also is a group of members who is not as fully immersed in the work of the ethics committee. If those new members want additional ethics skills, the committee offers educational modules. New members are expected to be a part of the working groups the committee creates.
Other than that, time commitment is somewhat flexible. Some members attend a few hour-long meetings a year and provide their perspective. Even if those members do not volunteer for anything else, it is a valued contribution, according to Bibler.
“Even if they are not the ones creating the policy or doing the education or doing the consult, they might provide an essential perspective on the activities that the committee is doing,” Bibler says.
For example, the committee recently discussed the findings suggesting there are a disproportionate number of consults requested for Black patients when compared to the hospital population. “We had a discussion on why that might be,” Bibler recalls.
A committee member, himself a racial minority, asked, “What if the issue is not that the service is getting an overabundance of consults about Black patients, but that White and Hispanic patients are not receiving the consults they need?”
“That is a valuable insight,” Bibler says. “I don’t think it is the best explanation for what is happening, but without his perspective, I am not sure where the conversation might have gone.”
Some ethics committees expect more from members than just intermittent attendance and occasional input. “There are limits to that. I don’t think you’d want 60 members who are just participating tangentially,” Bibler admits.
However, the members’ periodic observations have been valuable. “That type of stratification – having people who are intimately involved, and people who are tangentially involved, seems to be working for us,” Bibler reports.
Currently, the committee is reflecting on how to use members as “go-betweens” to bridge clinical units and ethics consultants. Ideally, the members will help clinical colleagues resolve ethical dilemmas. At a minimum, members can point people to ethics consultants who can resolve the issue. “Because of their skills, hopefully they would at least be able to identify that there is an ethics issue. It would be a huge advantage to be able to triage it to people they trust to start working up the issue,” Bibler says.
The committee motivates new members to become more involved by drawing from their areas of interest and expertise. However, there is no set expectation for the amount of time members need to devote to the ethics committee’s work.
“If they engage in a very substantial project and for the next few months they don’t participate in smaller projects, that is acceptable to me,” Bibler explains.
Recently, Bibler set out to create a task force for diversity, equity, and inclusion efforts. He gauged members’ interest via a general email. Some members were interested, and a meeting was held. It has not gotten off the ground yet, though, in part because the request was not targeted enough. “I learned the lesson that I need to make specific requests of these volunteers, based on their interests and competencies. I will likely not be making requests based on broad emails,” Bibler says.
Instead, Bibler will expand the use of targeted requests to show members that their expertise would be beneficial enough so that volunteering for the project would be worth their time. For instance, the committee might ask a palliative care physician to assist with creating a module on end-of-life ethics, due to the fact the committee receives many requests for information on this topic. “If we are judicious with our requests and specific about what we are looking for, we get good responses,” Bibler observes.
With diverse roles on the committee, it is important for everyone to share their perspectives freely. In the context of the ethics committee meetings, the bedside nurse’s perspective carries the same weight as a vice president’s. “Some committees have the opposite problem, with too many perspectives going on at the same time, resulting in too much noise and static. Where we struggle is that people might not always feel safe to share their perspectives,” Bibler says.
Ethics committee members might be accustomed to meetings in other forums with lateral peers or hospital leaders, where less senior staff are not empowered to speak up. “In the ethics committee meetings, we should ignore the letters next to our names,” Bibler says. “It’s about shared deliberation. Unless we have folks sharing, we’re not going to have a very robust deliberation.”
Leaders share tips on how they managed to successfully recruit more colleagues to serve.
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