Physicians Making Decisions for Unconscious Patients Without Family, Friends or Surrogates (2): Hospital Ethics Committees

Before going into the alternative approaches which has been suggested regarding dealing with the issue of treatment decisions of the unconscious patient who has no family, friends or surrogates and which would involve the hospital ethics committee, I would like to describe the history, composition and functions of those committees.

Hospital ethics committees began to be formed over 20 years ago as a need to consolidate the committees which had been created earlier to select patients for hospital renal dialysis, for abortion review and federally required review of the care given to critically ill infants. Actually, in the 1960s, US Catholic hospitals first created committees for the Discussion of Morals in Medicine.
The concerns about end-of-life issues triggered by the legal decision in the Quinlan case gave further motivation to create ethics committees.
Today, hospital ethics committees or some equivalent are required by JCAHO, a hospital certifying organization, as part of the goal to assure that the ethical concerns of patients are considered.

Although the committee will vary in size and composition depending on each hospital’s policy, there are usually about 20 or so members. The disciplines represented on the committee usually consist of physicians, nurses, spiritual care, social service, representative of staff departments such a respiratory care, members of the administration and, strongly encouraged is the presence of representatives of the community, not affiliated with hospital affairs. There also may be a professional ethicist present as well as a hospital lawyer. It may be true that many ethics committees do not really have multi-racial or multi-cultural members or members who are themselves or represent the disabled..

The function of the ethics committee is to educate its own members, the medical and nursing staff and the community about the ethics and law of various issues that arise in patient care. The committee also is involved in the offering and writing of policies and procedures dealing with activities involving clinical ethics. A very important role of the ethics committee is to provide for patients, families, physicians, nurses and any other hospital staff a resource for help in resolution of conflicts involving ethical issues. The ethics committee serves as an educator and mediator to help facilitate the resolutions of those conflicts. The hospital ethics committee cannot and will not make clinical decisions, which bear on standards of medical care. The committee is interested and considers aspects of care in which established standards of ethics are related. But hospital ethics committees do not act as “ethics police”. Most ethics committees only attend to cases in which some stakeholder has invited the committee.

With this brief description, we will shortly return to discussing the unconscious patient. ..Maurice.