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PubMed2005

The current state of clinical ethics and healthcare ethics committees in Belgium.

Ethics committees are the most important practical instrument of clinical ethics in Belgium and fulfil three tasks: the ethical review of experimental protocols, advising on the ethical aspects of healthcare practice, and ethics consultation. In this article the authors examine the current situation of ethics committees in Belgium from the perspective of clinical ethics. Firstly, the most important steps which thus far have been taken in Belgium are examined. Secondly, recent opinion by the Belgian Advisory Committee on Bioethics with regard to ethics committees is presented and the activities of Belgian ethics committees are discussed. Finally, the option to bring research ethics and clinical ethics under the roof of just one committee is criticised using a pragmatic and a methodological argument. Concomitantly, the authors build an argument in favour of the further development of ethics consultation.

Belgium↗
PubMed1985

Institutional ethics committees: what, how, and why.

Because institutional ethics committees can reduce the risk of tragic mistakes by clinical decision makers and provide interdisciplinary input into decisions, they may be a requirement for all hospitals by the end of this decade. Ethics committees should not in themselves be decision-making entities, however. Their proper functions are to advise physicians, patients, and families; facilitate communication; provide in-house education; assist in policy formulation; mediate between ethical theory and concrete medical judgments as well as between the institution's values and those of the larger community; provide support for those involved in painful decisions; and minimize the institution's vulnerability to litigation. Although ethics committees have been endorsed by federal agencies, a presidential commission, and numerous health care organizations, several obstacles remain. Physicians are afraid that their decisional prerogatives will be wrested from them; a committee could become a rubber-stamp organ for one powerful member, one special-interest group, or one perspective, confidentiality policies would have to be extended to nonhospital committee members; and medical personnel feel threatened by the exposure of errors or bad judgment. Nonetheless, ethics committees are a promising structural adjustment to ethical pressures exerted by new technology and the growing number of health care disciplines.

Ethical Review↗
PubMed2004

Ethics education and value prioritization among members of U.S. hospital ethics committees.

Calls for ethics education for members of hospital ethics committees presume that the effects and benefits of such education are well-established. This is not the case. A review of the literature reveals that studies consistently have failed to uncover any significant effect of ethics education on the moral reasoning, moral competency, and/or moral development of medical professionals. The present paper discuss this negative result and describes the author's national study of the value priorities of members of hospital ethics committees. This study discovered correlations between moral decision making and factors like age and type of institution where the committee operates. The results of this study also resemble those of previous studies in finding no correlation between ethics education and moral decision making. The author concludes that there is a need for more research on the effects of nonmoral personal, societal, and institutional factors on the moral reasoning of members of hospital ethics committees. Further, in the absence of any firm empirical basis, calls for ethics education for medical professionals and ethics committee members should be rethought.

Bioethical Issues↗
PubMed1992

Psychiatrists and the General Hospital Ethics Committee.

General Hospital Ethics Committees (GHECs) have emerged as institutional forums for addressing bioethical dilemmas. Hospital psychiatrists have important roles to play on these committees. Their skills in group process assessment, mental status examination, and character assessment have diverse applications. Psychiatrists can facilitate communication, both on the committee and as GHEC-based clinical ethics consultants. Ethics committees must be concerned with how they arrive at ethical decisions, guarding against political influence or individual monopolization. Psychiatrists can assist these efforts as organizational consultants to GHECs. The perception of psychiatrists as reflective, tolerant of ambiguity, humanizing, and approachable about moral aspects of health care suggests they would make excellent committee leaders. Hospital psychiatrists also have important committee roles to play as ethics educators and policy-makers. More demographic research is needed to investigate psychiatrists' participation on GHECs. Studies of how they are perceived by their ethics committee colleagues may reveal new roles and potential pitfalls for GHEC psychiatrists.

Decision Making, Organizational↗
PubMed1990

Ethics of caring and the institutional ethics committee.

Institutional ethics committees (IECs) in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed IECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel Noddings, is an unacknowledged basis for IEC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for IECs.

Decision Making↗
PubMedDate not supplied

Developing clinical ethics committees.

Formal clinical ethics review first developed in the USA and most hospitals there have structures in place. This is often a clinical ethics committee. Developments have been slower in the UK, where there has been uncertainty and variability about the role of clinical ethics committees. Even in the USA, their exact role is uncertain. Although we now have a good idea of the mechanisms for ethical review of clinical issues in NHS trusts and health authorities, the desirability, composition and terms of reference for clinical ethics committees should be agreed as part of the clinical governance agenda.

Ethics Committees, Clinical↗
PubMed1990

Hospital ethics committees.

The hospital ethics committee (HEC) is an entity that arose relatively recently, in the 1980s, in response to various concerns about how to choose the ethically correct path in dealing with a wide range of novel situations being brought about by the advances of medicine. This article recounts the hospital ethics committee's historical background, briefly defines its nature, describes the Argentine experience with it to the present, reviews existing guidelines for organizing and operating an HEC, and makes a number of recommendations designed to heighten awareness of the HEC's potential and promote its use.

Argentina↗
PubMed1992

Exploring the role of the ethics committee psychiatrist.

Healthcare ethics committees (HEC) have emerged as institutional forums for addressing bioethical dilemmas. Psychiatrists have important roles to play on these committees. Their skills in group process assessment, mental status examination, and character assessment have diverse applications. Psychiatrists can facilitate communication within the committee and as HEC-based clinical ethics consultants. HECs must be concerned with how they arrive at ethical decisions, guarding against political influence or individual monopolization. Psychiatrists can assist these efforts as organizational consultants to HECs. The perception of psychiatrists as reflective, tolerant of ambiguity, humanizing, and approachable about ethical aspects of health care suggests they would make excellent committee leaders. Psychiatrists also have important committee roles to play as ethics educators and policy makers. More demographic data is needed to investigate psychiatrist participation on HECs. Studies of how they are perceived by their ethics committee colleagues may reveal new roles and potential pitfalls for HEC psychiatrists.

Decision Making, Organizational↗
PubMedDate not supplied

Why do research ethics committees disagree with each other?

Research ethics committees have to ensure that research projects are asking sensible questions and are designed so that the questions will be answered, that the research subjects who are involved will not come to unnecessary harm, and that the autonomy of the research subjects will be respected. Where research proposals cannot fulfill all these criteria, research ethics committees have to perform a delicate balancing act amongst competing moral claims. These arise when, for example, the research is non-therapeutic or the research subjects are incompetent to give consent. Given that the balance of conclusions is so sensitive, it is hardly surprising that different committees sometimes disagree with each other.

Congresses as Topic↗
PubMed1984

Maryland hospitals get plan for creating ethics committees.

The Maryland Hospital Association's Advisory Committee on Medical Ethics, charged to assist member hospitals in forming ethics committees, focused on four concerns: study and development, physician support, patient/family participation, and potential issues. The committee recommended as a first step in establishing an ethics committee the creation of a study group. It warned hospitals not to expect a fully operational ethics committee immediately. A start-up period, according to the committee, should be used to develop a process for handling ethical questions and for educating the hospital community about the committee's role. To promote the best possible decision making, the hospital ethics committee should function as a support unit, for physicians as well as for patients, families, and hospital personnel. Clearly stated policies will provide a basis for appropriate intervention and help gain physician cooperation, the committee said. Such policies should encourage ethics committees to anticipate problems and to review decisions already made. While recognizing the need to involve patients' families in decision making, the advisory group agreed that the question of their presence at committee meetings should be addressed by each institution. In cases of controversial treatment or disagreement about the course of treatment, patient/family access to the committee should be clearly defined. The advisory committee suggested that each institution prepare its own list of topics that an ethics committee might consider. It also prepared a "model statement" of an ethics committee's purposes, membership, and procedures.

Ethics Committees, Clinical↗
PubMed1992

Are hospital ethics committees really necessary?

CONCLUSION: Ethics committees are crucial at this point in the history of medicine. They serve as a forum where various ethical issues can be raised, discussed, critically examined, and "where a number of disciplines come together to examine the implications of contemporary medicine upon life." If ethics committees are to be helpful, there must be realistic expectations and accurate descriptions of their functions. This writer, along with most others, would conclude that ethics committees should in no way be involved in the actual decision-making process. Rather, the IEC should involve itself only through educational offerings, policy development, and voluntary consultation at the request of a provider or a patient. This type of committee will avoid certain pitfalls which could compound the process of decision making and very possibly not be of benefit to the patient. The decision-making process belongs to the physician and the patient, not to an ethics committee.

Attitude↗
PubMed1996

Organization and function of a hospital ethics committee.

The developing ethics committee must address many issues around the structure and function of the committee. This article reviews such matters as membership, training, and committee policy. Committee functions are reviewed with suggestions about education as well as ethics consultation.

Accreditation↗
PubMed2005

[What are the clinical ethics committees doing?].

BACKGROUND: Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. To assess the quality and function of the committees, a national research project was initiated in 2004. METHODS: A questionnaire on composition, resources, qualifications, tasks and routines was mailed to all committees. The response rate was 75% (21 out of 28). RESULTS: The committees are interdisciplinary and meet on average nine times per year. Only three (14%) chairs have been given dedicated time. Ten (48%) committees have separate budgets. Major tasks include getting the committee established, educating employees, deliberations (cases and more general questions), and guidelines. Main issues are withholding and withdrawing treatment, communication, patient autonomy, involuntary treatment, and priority setting. 16 committees have specific deliberation procedures. Minutes were taken in approximately half of the case deliberations. Systematic evaluation is scarce. INTERPRETATION: During a short period the committees have increased their competence and served over 2000 hospital employees, mainly through seminars. The committees probably already contribute to quality assurance in ethical decision making. The committees want more case consultations. Important challenges are obtaining sufficient resources, making the committees better known, and establishing routines.

Clinical Competence↗