Hospital ethics boards are the local face of struggle for moral decision-making amid medical change. In hospitals large and small, ethics committees weigh grave questions about medical treatment. Most meetings are quiet and businesslike, dealing with hospital policy or board member education. Yet frequently, these committees are asked by patients, families, nurses or doctors to recommend action – or inaction – on difficult ethical questions involving the collision of new technology, religious beliefs, high costs and consumer demand.
Which patient should have an organ transplant? Who will be taken off life support? Should someone near death be resuscitated? How aggressively should new technologies be employed?
Ethics committees arose in the early 1970s as physicians, administrators and lay people wrestled with how to ethically use technology. Catholic hospitals were among the first to form them. Members are all appointed by the hospital and are usually hospital administration or medical staff. A member of the public and a chaplain also may be included. In response to increasingly complex decisions, many hospitals are adding experts in bioethics and offering more sophisticated training to help members make informed ethical decisions. While religion may play a stronger part in religious hospitals, the religious beliefs of families, doctors, nurses and administrators can be a factor in any patient’s treatment.
Why it matters
The toughest medical decisions concern when life begins, when it should end and how much money and effort should be spent to sustain or improve it. These decisions strike at core beliefs about the nature of life and death, beliefs that are often shaped by religion.
Story angles
- Has membership of area hospital ethics committees and the cases they consider changed over time? Who serves, and how are members chosen? Is training offered?
- What role, if any, does religion play in a committee’s deliberations? Do hospital chaplains or clergy have a role in the committee? Do they speak solely for their religious tradition or consider others? Are there differences in ethics committee membership and decisions between secular hospitals and hospitals owned by religious institutions and others?
- Ask committee members what the most difficult medical ethics issues on the horizon in your locale are. Draw out specifics and examples.
- Ask to see an ethics committee’s charter, usually a hospital policy, which outlines the minimum membership, roles and basics of operation. When was it established, and has it changed in response to changes in medical treatment?
A reporter can reasonably expect a hospital committee member to discuss deliberations that don’t include personally identifiable health information about patients. Professionals can be quite forthcoming with clinical examples without compromising confidentiality, says Tom Mayo, director of the Cary M. Maguire Center for Ethics and Public Responsibility at Southern Methodist University in Dallas.
National sources
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Tom Mayo
Tom Mayo is director of the Cary M. Maguire Center for Ethics and Public Responsibility at Southern Methodist University in Dallas. He has expertise in ethical questions involving Medicare fraud and abuse, organ transplantation, tax-exempt status of health care organizations and, particularly, end-of-life decision-making and advance directives.
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Arthur Caplan
Arthur Caplan is a professor of bioethics and director of the division of medical ethics at New York University’s school of medicine. He co-edited Assisted Suicide: Finding Common Ground.
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Kevin E. Lofton
Kevin E. Lofton is president and CEO at the Denver-based Catholic Health Initiatives. CHI is operated by a religious-lay partnership. It is one of the largest Catholic health systems firm in the country, with hospitals; long-term care, assisted and independent living and residential facilities; and community-based health organizations in 16 states.
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American Society of Law, Medicine and Ethics
The American Society of Law, Medicine and Ethics, based in Boston, aims to be a forum for debate, scholarship and critical thought among professionals who work at the intersection of law, health care and ethics. Contact executive director Ted Hutchinson.
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Carol Taylor
Sister Carol Taylor is former director of the Center for Clinical Bioethics at Georgetown University. She also is a senior research scholar at the Kennedy Institute of Ethics and a professor of nursing at Georgetown. Her background is in philosophy, bioethics and nursing. She is experienced in caring for chronically and critically ill patients and their families.
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Gilbert Meilaender
Gilbert Meilaender is a senior research professor at Valparaiso University in Valparaiso, Ind., and a fellow at the Notre Dame Center for Ethics and Culture. He was a member of the President’s Council on Bioethics from 2002 to 2009.
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Abdulaziz A. Sachedina
Abdulaziz A. Sachedina is a coordinator of the Islamic bioethics group of the International Association of Bioethics and is a professor of Islamic studies at the University of Virginia in Charlottesville. He contributed the entry on bioethics for The Oxford Dictionary of Islam.
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Ann Cook
Ann Cook is director of the National Rural Bioethics Project, based at the University of Montana in Missoula, where she is a professor of psychology. The project helps address ethics issues in rural communities.
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National Ethics Committee
The National Ethics Committee is a subcommittee of the Executive Committee of VHA’s National Leadership Board. It is not a hospital advisory committee in the traditional sense but is an interdisciplinary group from around the nation, charged to issue reports on ethics-related topics, ranging from resource allocation to impaired-consent capacity. It is monitored by the National Center for Ethics in Health Care and analyzes ethical issues affecting the health and care of veterans.
Background
History
- The first call for ethics committees was in 1971, when the Catholic Hospital Association of Canada and the Canadian Catholic bishops, in their Ethical and Religious Directives for Catholic Hospitals, recommended that Catholic institutions educate the hospital community on moral dimensions of life-sustaining technologies, establish a forum for dialogue about using technology and make ethics policy, according to writings by Elizabeth Heitman, associate professor at the Vanderbilt University Medical Center’s Center for Clinical and Research Ethics.
- There are two types of ethics committees: administrative or medical staff. They usually have three tasks: to educate administrators and the hospital community; to consult as requested on medical cases (no one is required to take the committees’ advice); and to set and review hospital policy. In ethics consulting, cases most often entail issues about the end of life, genetics testing and the appropriate use of technology.
- A committee’s services and ambitions vary widely, depending on resources and a hospital’s sophistication. Not all meet regularly; some convene just a couple times yearly or as required. In religious hospitals, ethics committees may or may not take religion into account, depending on the hospital.
Ethics standards
Here are some resources for writing about medical ethics:
- The American Society for Bioethics and Humanities, a society that fosters idea exchange and discussion among professionals, has a list of minimum competencies (called “Core Competencies for Health Care Ethics Consultation”) for bioethics consultants. It is frequently used by committees to help guide their composition and education. It also lists academic programs around the country.
- The American Medical Association has brief, broad guidelines for ethics committees. The AMA also offers guidelines for patients and physicians who want to invoke an ethics consultation. Committee training takes the form of self-education or seminars. Legal and medical students study ethics committees in texts and classes.
No journal or organization follows the world of ethics committees.Ethics boards are studied by American scholars, but perhaps not as widely as in Canada, Britain and Australia, with their centralized health care planning. Search the PubMed Central journal archive for article citations leading to authors and experts.
Regional sources
In the Northeast
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Lynn Pasquerella
Lynn Pasquerella is president of Mount Holyoke College in Massachusetts and has written about medical ethics. She formerly chaired the University of Rhode Island institutional review board.
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Dr. Alexandra Cist
Dr. Alexandra Cist, board-certified in internal medicine, pulmonary medicine and critical care medicine, is on staff at Massachusetts General Hospital, where she serves on the ethics task force and other ethics committees.
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Dr. Robert M. Arnold
Dr. Robert M. Arnold is director at the University of Pittsburgh School of Medicine’s Institute for Doctor-Patient Communication. Arnold teaches physician leaders how to educate peers to better communicate regarding ethical, psychosocial and existential issues at the end of life.
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Maryland Healthcare Ethics Committee Network
The Maryland Healthcare Ethics Committee Network, established by the Law and Health Care Program at the University of Maryland School of Law, serves as a resource for ethics committees. Contact chairwoman Diane Hoffman.
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Dr. Michael A. Williams
Dr. Michael A. Williams is medical director of the LifeBridge Health Brain & Spine Institute in Baltimore. He is former co-chairman of the Johns Hopkins Hospital Ethics Committee. His interest areas include end-of-life care and the ethical issues of organ donation, of intracranial pressure and of hydrocephalus.
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Dr. John Collins Harvey
Dr. John Collins Harvey, a physician with a doctorate in theology, is senior research scholar and professor emeritus of medicine of the Georgetown University Center for Clinical Bioethics in Washington, D.C. His bioethics interests include withdrawal of treatment, advance directives, euthanasia and physician-assisted suicide. Contact him via the website.
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Anne Griswold Peirce
Anne Griswold Peirce is a professor of nursing at Adelphi University in Garden City, N.Y. She published the paper “Some Considerations about Decisions and Decision-Makers in Hospital Ethics Committees” in the Oct. 14, 2004, issue of the Online Journal of Health Ethics.
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Stanley Joel Reiser
Stanley Joel Reiser is faculty of the University of Texas Health Science Center at Houston School of Public Health, Austin Regional Campus, as adjunct professor, and a visiting professor of physician assistant studies and of health policy at The George Washington University School of Medicine and Health Sciences in Washington, D.C. He co-edited Integrity in Health Care Institutions: Humane Environments for Teaching, Inquiry and Healing (University of Iowa Press, 1990) and wrote the chapter “Hospitals as Humane Corporations.” His research is on the intersection of medicine and public health, including experimental therapies.
In the South
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Ruth Gaare Bernheim
Ruth Gaare Bernheim, an attorney and public health expert, is associate director of the University of Virginia Institute for Practical Ethics and Public Life. She has served as an adviser to numerous hospital ethics boards and has taught a course on ethical issues in the evolving care delivery system.
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Kenneth R. White
Kenneth R. White is a professor of health administration at Virginia Commonwealth University’s School of Allied Health Professions in Richmond. He is a registered nurse with clinical and administrative experience and has also worked in hospital operations and marketing. He has written about end-of-life care, charity care, HIV care and the administrative concerns unique to Roman Catholic hospitals.
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Philip A.D. Schneider
Philip A.D. Schneider, professor emeritus of philosophy and religion at Coastal Carolina University, wrote a paper on his study of 12 hospital ethics committees in eastern South Carolina.
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Christine E. Gudorf
Christine E. Gudorf, professor of religious studies at Florida International University in Miami, has written about the issues of integrating ethics into hospital care. She teaches a course on reproductive ethics and wrote a chapter on contraception and abortion among Catholics for the book Sacred Rights: The Case for Contraception and Abortion in World Religions.
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Baruch A. Brody
Baruch A. Brody is a professor of biomedical ethics and the former director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston.
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Barbara A. Mulich
Barbara A. Mulich is a palliative care nurse practitioner at the Robert C. Byrd Health Sciences Center at West Virginia University in Morgantown.
In the Midwest
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Dawn H. Seery
Dawn H. Seery is a system ethicist for Mount Carmel Health System in Columbus and serves on the board of trustees for the Bioethics Network of Ohio. Dawn has been involved in hospital ethics committees since the 1980s. Her background includes critical care and palliative care education and management. Her graduate degree is in bioethics and health policy.
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Dr. Ruth M. Farrell
Dr. Ruth M. Farrell is a Cleveland physician with a background in bioethics and philosophy. She is particularly interested in assisted reproductive technologies and treatments for infertility patients. Farrell serves on numerous hospital quality assurance and ethics committees. She founded the obstetrics and gynecology residents’ ethics curriculum at the University Hospital of Cleveland.
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Richard L. Wiener
Psychology professor Richard L. Wiener lead a research team at the University of Nebraska-Lincoln that studied the impact of law on everyday behavior, the implementation of law in the legal system, and the fit between the law and assumptions about human conduct. The team has studied hospital ethics boards’ end-of-life recommendations.
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David Orentlicher
David Orentlicher, a physician and lawyer, co-directs the health law program and teaches law at the University of Nevada, Las Vegas. He is an expert in bioethics, health law, health-care planning and abortion and previously served as director of the American Medical Association’s Division of Ethics Standards.
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Valarie Blake
Valarie Blake is a senior research associate at the American Medical Association’s Council on Ethical and Judicial Affairs in Chicago. She assists the council by researching ethics topics of medical interest and developing policy and responds to inquiries concerning AMA ethics policy.
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Ohio Health Care Ethics Committees Information Project
The Ohio Health Care Ethics Committees Information Project, run by Cleveland State University, has surveyed hospital ethics committees throughout the state twice.
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Stephen Streed
Stephen Streed is director of chaplaincy for Eventide Lutheran Senior Communities, based in Moorhead, Minn. He can talk about the composition of the ethics committee at the home and about issues facing ethics committees in geriatric situations.
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Paige Cunningham
Paige Cunningham is an attorney and educator who is the executive director of The Center for Bioethics and Human Dignity in Deerfield, Ill.
In the West
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Nancy Scheper-Hughes
Nancy Scheper-Hughes is director of Organs Watch, a human rights documentation center that tracks the ethical and legal uses and sources of transplant organs globally. Scheper-Hughes is also a professor of medical anthropology at the University of California, Berkeley.
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Margaret McLean
Margaret McLean is a senior lecturer in the religious studies department at Santa Clara University in California and associate director and director of bioethics for the Markkula Center for Applied Ethics. Her background is in life sciences and divinity; she has a doctorate in ethics from the Graduate Theological Union in Berkeley. She teaches Christian ethics, religion and science, and medical ethics.
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Jennifer M. Shaw
Jennifer M. Shaw is a regional ethicist for California with the Office of Ethics and Theology for Providence Health System, which has facilities in Alaska, Washington, Oregon, Montana and California.
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Barbara A. Koenig
Barbara A. Koenig is a profesor with the Institute for Health and Aging at the University of California, San Francisco.
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Patrick McCormick
Patrick McCormick is a professor of religious studies at Gonzaga University, in Spokane, Wash., where he teaches about Christian ethics, medical ethics and Catholic social teachings. He is author of Sin as Addiction (Paulist Press, 1989) and Character, Choices & Community: The Three Faces of Christian Ethics (Paulist Press, 1998). He has served as a consultant on various hospital ethics boards. Ask him about how Catholic guidance affects decision making in hospital ethics committees.