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At least 19 recordsLinked to original sources
PubMed1989

Initiating and maintaining an ethics committee.

Ethics committees are an evolving approach to conflict resolution. They provide education and set Institutional policy. They are an exciting and sometimes frightening reflection of changing health care, as issues involving allocation of scarce resources, withholding or withdrawing treatment, autonomy and the patient's right to refuse treatment, and access to care arise in clinical care. This article has described how to initiate and maintain an ethics committee, as well as the nurse's pivotal role in identifying conflict and assisting in conflict resolution. Cranford and Roberts offer a few timeless tips for the beginning committee. They advise forming the committee with three or four people who have expressed interest, rather than recruiting those who may lose interest. More than three or four people may be needed to conduct committee business, so if recruiting is necessary, select compassionate people who are not likely to monopolize the meetings. Likewise, the chair should be affable yet assertive. Recognize that ethics committees will function differently from institution to institution, so comparisons may not be helpful. Proceed toward goals, but pay attention to the process of committee function and modify the process as needed. Finally, proceed at a pace most comfortable to members of the committee and to the institution. The pace may seem slow, but attitudes toward the committee, which may be negative at first, are slow to change. The end result is a viable body of caring people to address the needs of its institution, its staff, and most importantly, its patients and families. That is the goal we all seek.

Ethics, Medical↗
PubMed1992

Auditing a research ethics committee.

Research ethics committees approve research on human subjects performed locally. They have been criticised for failing to perform this function adequately. I have, therefore, examined the structure and process of the committee for Leicestershire and compared it with the guidelines for these committees produced by the Royal College of Physicians and the Department of Health. The structure and function of the committee are described and conform well with the recommendations of the Royal College of Physicians and the Department of Health. An annual report to the health authority has not previously been produced but the need for this is now accepted. The suggestion for a lay chairman or vice-chairman has, however, been rejected. The workload has steadily increased over the past 10 years, from 66 protocols a year to 302. During a recent 12-month period, 277 research submissions were received; 143 of them were agreed without amendment, 93 with minor amendments, and 41 were rejected or required further information before they could be reconsidered. Assessment of outcome is more difficult. In future, the committee may ask for annual reports from investigators on their research and on any ethical problems encountered. Ethics committees need to foster good ethical research and inform researchers of ethical issues. Most of the latter are highlighted on the Leicestershire application form but are supplemented by short guidelines on particular topics. The committee consumes time and money; it is not clear if it will be adequately funded under the new NHS structure.

England↗
PubMed1989

Giving answers or raising questions?: the problematic role of institutional ethics committees.

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver.

Cultural Diversity↗
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

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↗
PubMed1990

Ethics committees.

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Ethics, Medical↗
PubMedDate not supplied

Ethics committees.

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Ethics↗
PubMed1991

Ethics committees.

Three kinds of ethics committees should be distinguished, the mandatory local hospital or clinic-based committee, the statutory national committee set up to issue licences, or survey issues highlighted by local committees, or in the national press, reporting to Parliament, and publishing annual reports; and the committee established either temporarily or on a permanent basis to examine outstanding and general problems in the morals of medical practice and research, and to advise Ministers as to possible changes in the law. At all levels, such committees will be concerned with moral problems, and can never, therefore, be expected to come up with uniquely 'correct' solutions. Nevertheless they are essential both to reassure the public and to give guidance to the medical profession, both in clinical practice and research. Such committees should, at all levels, have a non-medical chairman, and a high proportion of 'lay' members. They must have regard to common moral sentiments, and to what will be morally acceptable in the country as a whole (though they can never hope for total agreement with their conclusions). Their recommendations, being in the sphere of public rather than private morality will be as far as possible the outcome of consensus, without which legislation is not possible.

Advisory Committees↗
PubMed1989

Institutional ethics committees: a survey of children's hospitals.

Institutional ethics committees first gained national prominence after the 1976 Karen Ann Quinlin decision by the New Jersey Supreme Court. However, it wasn't until the Federal Government promulgated the Baby Doe regulations in 1983 that significant movement occurred toward implementing such committees. Currently, statistics show that the number of ethics committees are increasing in health care institutions across the country. However, the majority of studies have focused on adult institutions. The membership of ethics committees and the objectives under which the committees function are usually addressed by the studies. Very little attention has been given to the nursing representation on the institutional ethics committee and the unique role played by nurses in the deliberation of ethical decision-making. It is the intent of this research to shed some light on the availability and functions of ethics committees within children's hospitals. Attention has also been given to the nurses' involvement on such committees. Additionally, the study takes a separate look at nursing ethics committees, their function within an institution, and the availability of ethics education for nurses. The study offers information not previously acknowledged in past studies of ethics committees. The study also opens up to consideration the unique concerns of nurses and their roles in ethical decision-making.

Child↗
PubMed1990

Ethics committees and health services research.

Ethics committees in Britain were set up to consider clinical research. Increasingly, however, they are receiving applications for health services research which often involves several or many centres. The performance of 23 ethics committees was examined through a case-study of an application for a multi-centre non-experimental study of prostatectomy. Although all the committees approved the study, long delays occurred (mean 11.5 weeks, range 3-32 weeks), particularly in teaching districts which dealt with large numbers of applications. The composition of the committee and the frequency with which it met were not associated with the time taken to reach a decision. Some delays might be reduced by improving the design of the application forms and ensuring that at least one member of the committee has an understanding of health services research methods. Although such measures might improve the performance of committees, applicants are likely to remain in a logistic trap between funding bodies, clinicians, and ethics committees. In addition, until committees temper their concern for individualistic medical ethics with a collective ethic of the common good, health services research may continue to experience delays and difficulties.

Decision Making, Organizational↗
PubMed1988

Grassroots grappling: ethics committees at rural hospitals.

Institutional ethics committees are a well-established mechanism for dealing with ethical dilemmas at large health-care institutions. The presence of these committees at small rural hospitals is a recent phenomenon. Because such hospitals are nonspecialized and isolated and have limited resources, they do not naturally encourage the development and growth of ethics committees. The experience of larger institutions with such committees is not readily adaptable, and role models are lacking. The experience of rural Vermont hospitals with ethics committees shows that these committees can function fully at small hospitals and have three stages of development. To accelerate the evolution of ethics committees at small rural hospitals, networking between these hospitals and an association with academic centers are needed. State medical societies can also support these committees by endorsing and sharing resources.

Ethics↗