Physicians Making Decisions for Unconscious Patients Without Family, Friends or Surrogates (5): Ethics Committees--True Consensus?
In both of the two options involving hospital ethics committees(HEC) (see last posting) the same concern can be raised. The concern is does their final conclusion really represent a true consensus of opinions or something else? How is the final conclusion that the committee reaches developed?
Anne Griswold Peirce, RN, PhD, Associate Dean for Academic Affairs, Columbia University School of Nursing, New York writing in the Online Journal of Health Ethics, The University of Mississippi Medical Center explores some of the dynamics of decision-making by hospital ethics committees in this recent article titled “Some Considerations about Decisions and Decision-Makers in Hospital Ethics Committees”
Her cautions are well taken and are summarized by her as follows:
1. Ensure that HECs are composed of diverse professions, as well as diversity of gender and ethnicity. Diversity strengthens decisions by expanding the knowledge and opinion base (Smith, Bisanz, Kempfer, Adams, Candelari, & Blackburn, 2004).
2. Include community representation so that not all members are institutionally based. Diversity of institutional information is also important. Institutional allegiance may also influence decisions in unknown ways (DeRenzo, Silverman, Hoffman, Schwartz, & Vinicky, 2001; Deville & Hassler, 2001)
3. Make sure that the professionally powerful voices, for example physicians and lawyers do not override the other committee members’ opinions. DeVille & Hassler (2001) note that when lawyer members of HECs speak, other members may not feel any further discussion is needed. HECs might consider the technique of the military where some military tribunals vote in reverse order of seniority.
4. Consider the pooled opinion technique described by Surowiecki (2004) in the Wisdom of Crowds. Within the HEC meetings opinions might first be gathered on a paper ballot allowing each voice to be heard as an individual before pooling. As Surowieki (2004) notes no one expert is consistently right and pooled opinions are on average better than the individual.
5. Require ethics training for all members (Wilson, 2002). Exposure to the techniques of ethical analysis gives a common frame of reference for all committee members.
6. All information provided to HECs should be adequate in volume and organized in such a manner as to be interpretable by the committee. Clinical evidence should follow standard guidelines and reflect the best evidence available. Decisions should occur only after all relevant information is considered. However, committees should be aware that more information may not be better; it may only increase error (Kosko, 1993).
Note: The references are listed in the full article.
If any of my visitors here are associated with hospital ethics committees, posting their comments here on this article is most encouraged. Of course, others are encouraged to write too! ..Maurice.