HOSPITAL ETHICS

COMMITTEES

Bioethics Mahboob Ali Khan

MHA,CPHQ

Mission

Hospital Ethics Committee

To create a mechanism to allow the patient or the patient’s

designated representative to participate in the

consideration of ethical issues that arise in the care of

the patient; to provide an organization and mechanism

for the consideration of ethical issues arising in the care

of patients; and to provide education to care givers and

patients on ethical issues in health care.

Bioethics Issues:

Past and Present

• Defining Death

• Foregoing/Withdrawing

Treatment

• Permanently Unconscious

Patients

• Withholding Food and

Fluids

• In Vitro Fertilization

• Surrogate Parenting

• Fetal Tissue Research

• Euthanasia, Active and

Passive

• Abortion

• Genetic Engineering

• Assisted Suicide

• Organ Transplantation

• Do Not Resuscitate

Orders

• Informed Consent

• Access to Care/Indigent

Care

• Allocation of Scarce

Resources

• Cloning

Brief History of the Bioethics Movement

• 1962 Kidney Dialysis --”Patient Selection Committees”

• 1968 Definition of Irreversible Come (Brain Death) by

ad hoc Committee of Harvard Medical School

• 1976 Karen Ann Quinlan --Prognosis Committees”

• 1980-83 President’s Commission for the Study of

Ethical Problems in Medicine and

Biomedical and Behavioral Research

• Early 80’s Ethics Committees Emerging:

1981 Less than 1% of Hospitals

1985 50% of Hospitals

Today 75% of Hospitals

• 1982 Baby Doe Care (esophageal atresia)

• 1989 Nancy Cruzan – right to die; removal of feeding tube

Joint Commission on Accreditation of

Health Care Organizations

Standard: “Patient Rights and Organizational Ethics”

• Promote consideration of patient values and preferences

including decision to continue treatment

• Recognize hospital’s responsibilities under the law

• Inform patients of their responsibilities in the care process.

• Manage the hospital’s relationships with patients and the

public in an ethical manner.

Hospital Ethics Committee

Membership

Profile:

7 Physicians

1 Dentist

6 Nurses

1 Social Worker

1 Philosopher

1 Clergywoman

2 Attorneys

1 Hospital Administrator

20

Responsibilities of

Hospital Ethics Committee

• Education - facilitate educational opportunities for health

care professionals, patients, and their families.

• Consultation - provide consultative services regarding

ethical issues pertaining to a specific patient.

• Policies and Procedures - discussion and evaluation of

policies and procedures having ethical implications.

Education

Principles of Patient Care

• Each patient shall be treated as a whole,

irreplaceable, unique and worthy person.

• The patient’s safety, health, or welfare shall be

protected and shall not be subordinated to

organizational, staff, educational, or research

interests or to any other end.

Principles of Patient Care (cont.)

• Behavior reflecting the dignity, responsibility and

service orientation of health care professions worthy

of the public’s respect and confidence, shall be

practiced by all individuals.

• Each patient shall have a responsible attending

physician or dentist.

Principles of Patient Care (cont.)

• The privacy of the patient and the confidentiality of

every case and record shall be maintained.

• Patients and/or responsible family shall be informed

at all stages of care about personnel responsible for

the patient care, treatment plans, and activities for

the patient, facilities and services available to the

patient, and responsibilities of the patient and family.

Informed Consent

Respect for Autonomy

Beneficence

Consultation

Policies and Procedures

Withholding/Withdrawing

Potentially Life Sustaining

Treatment

-- Hospital Policy --

Levels of Support

(Do not resuscitate orders)

Level 1 Full support, including CPR

Level 2 Full support, excluding CPR

(DNR)

Level 3 Modified support, excluding

CPR (DNR)

May include: ventilation,

entral feeding, dialysis,

antibiotics, etc.

Guidelines on Pain Control for

the Dying Patient

Resource Materials for a

Establishing A Hospital Ethics

Committee

Our Committee Can Present

Programs On:

• Basic Principles of Bioethics

• Withholding/Withdrawing Policies

• Futile Treatment

• Informed Consent

• Managed Care Ethics

• Consultation Competencies

and with adequate notice and time to prepare,

other topics of interest in bioethics.