Scribd
Upload
25 views

Week 11-Ethics Committees & The Consultation Process

The ethics consultation process involves 6 essential steps: 1) gathering all relevant facts, 2) clarifying the ethical dilemma and issues in conflict, 3) identifying all stakeholders, 4) considering all management options, 5) making final recommendations based on the best ethical option, and 6) following up on the consultation. The goal is to provide a structured approach to identifying, analyzing, and resolving moral problems in patient care through open discussion and consideration of all viewpoints.

Uploaded by

Vidya Bala
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
25 views

Week 11-Ethics Committees & The Consultation Process

The ethics consultation process involves 6 essential steps: 1) gathering all relevant facts, 2) clarifying the ethical dilemma and issues in conflict, 3) identifying all stakeholders, 4) considering all management options, 5) making final recommendations based on the best ethical option, and 6) following up on the consultation. The goal is to provide a structured approach to identifying, analyzing, and resolving moral problems in patient care through open discussion and consideration of all viewpoints.

Uploaded by

Vidya Bala
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 29

The Ethics Consultation

Process

PA630: Medical Ethics and Professionalism

Spring, 2017

Wednesday 12:00-1:50pm
HEC 103
“Traditional” Medical Ethics
Physician centric
Professional and Virtue ethics (Hippocratic Oath)
“Good of the patient”
Paternalistic
• Physician gave orders
• “Good” patients were compliant
• Nurses and others were obedient & supportive
Emergence of Emphasis on Patient
and “Clinical Ethics”
 Emergence of “Patient Rights”
- Autonomy
 Concept of informed consent
- Right to refuse treatment
 Change in nursing and other providers’ ethics
- From loyalty to physician to patient advocate
“Clinical” Ethics
“…the identification, analysis, and resolution of
moral problems that arise in the care of a
particular patient.”1

 Care of patients is an ethical activity, and


includes:
 Personal ethics (of patient and families)
 Ethics of other professionals (other
providers, nurses, social workers, clergy,…)
Decisions are “Human Decisions”
Not just:
• “medical” decisions
• “nursing” decisions
• “social” decisions
• “Administrative”
• “Legal”
• “Moral”
• “Consumer”
• Or even simply “ethical” decisions…
History and Development of
Medical Ethics Committees
1976 - Karen Quinlan
In a ruling by New Jersey Supreme Court
responding to a request by her parents to take
her off a respirator the court designated a role
for a hospital ethics committee.
1983 - President's Commission
President's Commission for the Study of Ethical
Problems in Medicine and Biomedical and
Behavioral Research encouraged creation of
hospital ethics committees in its report,
“Deciding to Forego Life-Sustaining Treatment”
1984 – Baby Doe Rules
In its 1984 Baby Doe rules, the federal
government recommended establishment
of infant care review committees, which
promoted the growth of hospital ethics
committees
1992 - JCAHO
Joint Commission on Accreditation of
Healthcare Organizations required
establishment of a mechanism to provide “…
education to caregivers and patients on ethical
issues in health care…”
1986 - American Hospital Association
“Handbook for Hospital Ethics Committees”
Three primary functions:
1. educating medical staff, hospital staff, and
patients and community
2. developing institutional policies and guidelines
concerning bioethical issues
3. consulting and reviewing cases
Ethics Committees Roles:
1) review of treatment decisions made on behalf of
incompetent, terminally ill patients;
2) review of medical decisions having ethical implications
with the option, in cases of disagreement, to refer cases to
a court with proper jurisdiction;
3) provision of social, psychological, spiritual, or other
counseling for patients, family members, physicians, or
other hospital staff;
4) Establishing guidelines regarding treatment or other
medical decisions;
5) Sponsoring or conducting educational programs to inform
all concerned, including the public, about ethical problems
in medicine.
Composition of Ethics Committees

Gary Larson
Types of Ethics Consultations
1. Case consultations – an active clinical case
(includes interaction with the patient (or
surrogate) and documentation in the health
record)

2. Non-case consultations - answering questions


about ethics topics, interpreting policy, reviewing
documents, providing ethical analysis of
organizational questions, and responding to
hypothetical or historical questions.
Differing Approaches

 Individual Experts

 Small Teams

 Full Committees
Essential Components of
an Ethics Consultative Process

1. What are the facts?


2. What is the ethical dilemma?
Which values are in question or conflict?
3. Who is involved or affected (stakeholders)?
4. What are the possible options?
5. What is the best option?
1. Gathering Facts
 Medical problems / clinical facts
 Treatments and actions taken
 Goals of treatment, patient preferences
 Competence, surrogates
 Benefits, risks, understanding and consent
 Quality of life issues
 Conflicts of interest, family, professional issues
 Confidentiality
 Issues of justice, fairness, institutional, public
 Financial, legal, religious, other
…Facts - Inclusion of All Involved

 Patient
 Personnel involved in care
 Family
 Communities of care
...Facts - Social and Economic Factors

 Costs: human, economic, financial,


resource, social
 Who will pay these costs?
 How will these costs be paid?
...Facts - Quality of Life

 Patient’s perspective

 4 Boxes prompts
2. Clarify Ethical Dilemma & Issues

 Dilemmas

 Ethical principles, values at conflict

 Differing opinions regarding


consequences of various options
Defining the “Ethical Dilemma”
- How does the person requesting
consultation frame the problem?

- What do they find particularly troubling?

- How do their values, beliefs, faith &


intellectual commitments shape their
understanding of & response to the
dilemma?
Ethical Issues and Values

Review all ethical issues and values


that are relevant or come up in the
discussion.

Include all participants viewpoints.


3. Identify Stakeholders
 Identify all stakeholders

 Patient

 Family, friends, communities

 Providers, clinical team

 Others (payers, institutions)


4. Consider Management Options

 All options considered

 Ethical rationale for each


5. Final Recommendations

 Best option

 Note disagreements, minority / majority


opinions
Recommendations -
Need to Include Legal Aspects

Note relevant laws and regulations


(after consideration of ethical issues)

Consider previous cases.


Recommendations - Documentation
1. Names of all on Committee
2. The stated ethical concern
3. List of stakeholders
4. Summary of case
5. Summary of ethical issues considered, with
possible courses of action
6. List options considered
7. Final recommendations, with ethical
rationale
6. Follow-up

Feedback

Evaluation of process and outcomes

You might also like