The Work and Issues for Clinical Ethics Committees: Some Examples
Clinical ethics is the ethics of how medical care and treatment of patients is carried out by the various responsible professionals and others. Currently, the practice of clinical ethics is carried out in hospitals and nursing facilities by a hospital ethics committee or some committee in these other facilities. Multidisciplinary clinics may also have a committee but physicians and their patients in independent office practice have no direct consultation regarding ethical issues except hospital ethics committees may take on their requests.
The consultative component of a hospital ethics committee is made up either by a single consultant, so-called “clinical ethicist” or by consultative ethics committee made up of 3 or 4 members of the main committee.
The role of the consultation is toward reviewing the history of a case, assessing conflicts or concerns and then providing the stakeholders (physicians, nurses, patients, family members, hospital administration and other staff members) with education of the ethics and the laws applicable to the case and the ethical alternatives as the committee attempts to mediate any conflicts.
There are a host of issues that currently would be and should be considered in the domain of clinical ethics committees. Jeffrey Spike, professional ethicist and teacher, has outlined a series of 22 such issues.
1. disputes about a patient’s decision making capacity
2. choosing the right surrogate for an incapacitated patient
3. deciding surrogate decision making standards
4. interpreting advance directives
5. disagreements among staff or family members
6. questions about withholding or withdrawing treatment
7. end of life options of last resort
8. difficult and noncompliant patients
9. patients refusing beneficial treatment
10. negotiating futility (requests for non-beneficial treatment)
11. negotiating complementary and alternative medicine
12. patients’ rights for vulnerable groups (Mentally Retarded Developmentally Disabled, illegal immigrants)
13. the rights of minors as patients and the role of their family
14. issues concerning pregnancy, termination, and delivery
15. what to include in full disclosure for informed consent
16. informed consent for HIV testing and surrogate tests
17. PVS, ‘Brain Death’ and transplantation
18. disclosure of mistakes
19. ‘Quality of Life’ and Disability
20. safe discharge plans vs. right to live at home with risk
21. deciding when (or whether) to call state agencies
22. uncertainty about health law or hospital policy
There are more, nevertheless this list is good for a discussion on this thread. A number of these issues have already been discussed in one fashion or another on a number of the over 670 topics on this blog. I thought, however, I would like to put a potpourri of them on one thread and have the visitors ask questions about any of them and discuss my or others responses. Many of these issues have no absolute right or wrong solutions, some have established consensus of ethical opinion or written state or federal laws to follow. Not all these issues are fully understood by the public or by physicians. Pick one and write what your suggestion would be to an ethics committee on how the committee should handle the issue. ..Maurice.