Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-27T19:28:55.476Z Has data issue: false hasContentIssue false
  • English
  • Français

Are Ethics Committee Members Competent to Consult?

Published online by Cambridge University Press:  01 January 2021

Diane Hoffmann ,
Anita Tarzian  and
J. Anne O'Neil
Get access Rights & Permissions [Opens in a new window]

Extract

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute a consult. As one bioethicist commented:

if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 28 , Issue 1 , Spring 2000 , pp. 30 - 40
Copyright
Copyright © American Society of Law, Medicine and Ethics 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Shalit, R., “When We Were Philosopher Kings: The Rise of the Medical Ethicist,” The New Republic, 216, no. 17 (1997): 24–28; Bailey R., AWarning: Bioethicists May be Hazardous to Your Health: The Moralists' Attack on Medical Progress and Patient Freedom,@ <http://reason.com/9908/fe.rb.warning.html> (August/September, 1999): 1–13.Google Scholar
Blake, D., Vital Signs 75, (September, 1998): 1–2.Google Scholar
“Experts in Ethics?: The Authority of the Clinical Ethicist,” Hastings Center Report, 28, no. 6 (1998).Google Scholar
The Task Force adopted an “ethics facilitation approach and rejected an “authoritarian” and “pure facilitation” approach. The ethics facilitation approach includes two core features: “identifying and analyzing the nature of the value uncertainty and facilitating the building of consensus.” See “Core Competencies for Health Care Ethics Consultation,” American Society for Bioethics and Humanities, (1998), herinafter “Core Competencies,” at 6.Google Scholar
The Task Force consisted of scholars from the Society for Health and Human Values and Society for Bioethics Consultation. These two groups subsequently merged and are now the American Society for Bioethics and Humanities.Google Scholar
See Core Competencies, supra note 4.Google Scholar
Id. at 12.Google Scholar
Id. at 13.Google Scholar
Id. at 14.Google Scholar
Id.Google Scholar
Id. at 16–21.Google Scholar
Ethical Currents, no. 52 (Winter, 1998).Google Scholar
The Task Force delineates basic ethics consultation skills and knowledge that each member of a consulting team needs to be deemed “competent.” In addition, the Task Force recommends that at least one member of the consult team have advanced knowledge in certain areas. The only advanced skill that we included, which was not required for all team members, was “the ability to educate involved parties regarding the ethical dimensions of the case.” See “Core Competencies,” supra note 4 at 15)Google Scholar
See MD. CODE ANN., HEALTH-GEN. II ° 19–371 to 374 (1996).Google Scholar
It was modeled, in part, after a survey conducted by Hoffmann in 1990 that gathered information on demographics and operations of ethics committees, but did not ask about education of committee members. See Hoffmann, D.E., “Does Legislating Hospital Ethics Committees Make a Difference? A Study of Hospital Ethics Committees in Maryland, The District of Columbia, and Virginia,” Law, Medicine & Health Care, 19, nos.1–2 (1991): 105–119. This instrument was used in order to compare changes in committee structure and operations of ethics committees in Maryland between 1990 and 1998.Google Scholar
Knowledge questions included general ethical concepts as well as content specific to Maryland healthcare policy.Google Scholar
See “Core Competencies,” supra note 4 at 14–15.Google Scholar
Fox, E. Stocking, C., “Ethics Consultants' Recommendations for Life-Prolonging Treatment of Patients in a Persistent Vegetative Stage,” JAMA, 270 (1993): 2578–2582.Google Scholar
This demonstrates the problem of attempting to measure ethics knowledge quantitatively—since the only questions included were ones in which there was consensus among experts as to the answer, the result was a low variance in response scores, which contributed to the low reliability score.Google Scholar
Healthcare Infosource, Inc., a subsidiary of American Hospital Association, One North Franklin, Chicago, IL. Three of the 70 hospitals listed had either closed or had merged with another hospital making the total sample size 67.Google Scholar
The study was determined to be exempt from the University of Maryland's Institutional Review Board (IRB) process. (Memo to Diane Hoffmann from the University of Maryland, Baltimore IRB on June 8, 1998.)Google Scholar
Other types of members listed by one or two committees included risk managers, patient representatives, hospital security services, representatives from hospice, mental health, home health and the hospital board. This is relatively consistent with findings of a study of ethics committees in 1990 in Maryland, the District of Columbia, and Virginia. See Hoffman, D.E. supra note 15, at 108. However, this more recent study found that more committees included a representative of the hospital administration, more included a lawyer, and fewer included an ethicist, than was the case ten years ago.Google Scholar
Just over ten percent of committees (12.5%) had chairs who were social workers, nurses, or administrators. Two committees (5%) had chairs who were chaplains or members of the clergy.Google Scholar
Institutional response rate = percentage of individuals at each institution who were identified by chairs as able to perform ethics consults, and who responded. Thus, if in Phase I a chair identified 9 individuals as able to perform ethics consults and 3 returned the survey in Phase II, the institution would have a 33% response rate.Google Scholar
One individual did not answer this question, one reported performing 40 consults, and one reported performing 80 consults. To avoid inflation of the mean number of consults due to the outlier of 80 consults performed, that value was “windsorized' in statistical computations from 80 to 41.Google Scholar
Statistical significance levels should be interpreted conservatively, as assumptions for statistical tests were not always met (e.g., unequal group sizes were unavoidable, and severely skewed distributions were corrected through logarithmic transformation for running the Pearson correlations but not for the ANOVA tests). In addition, multiple testing increased the possibility of a fishing error. Results could be interpreted more cautiously by using a significance level of .025 instead of .05 to determine statistical significance.Google Scholar
Lawyers' responses were not analyzed separately as the group was too small (n=9) for a statistically robust comparison.Google Scholar
This includes two individuals with a Masters in bioethics, and the rest with a Masters or PhD in an ethics-related discipline (see text for how this was interpreted by respondents).Google Scholar
Negatively skewed distributions for “number of consults performed” and “perceived familiarity with ethics-related hospital policies” were normalized through logarithmic transformation.Google Scholar
See “Core Competencies,” supra note 4 at 30.Google Scholar
Id.Google Scholar
Bandura, A., “Self-Efficacy: Toward a Unifying Theory of Behavioral Change,” Psychology Review, 84 (1977): 191–215.Google Scholar
Parle, M. Maguire, P. Heaven, C., “The Development of a Training Model to Improve Health Professionals' Skills, Self-Efficacy and Outcome Expectancies When Communicating with Cancer Patients,” Social Science & Medicine, 44, no. 2 (1997): 231–240.CrossRefGoogle Scholar
The SUPPORT Principal Investigators, “A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), JAMA, 274, no 20 (1995): 1591–1598. See also Baile, W.F., “Communication Skills Training in Oncology. Description and Preliminary Outcomes of Workshops on Breaking Bad News and Managing Patient Reactions to Illness,” Cancer, 86, no. 5, 887–897, and see Cantwell, B.M. Ramirez, A.J., “Doctor-Patient Communication: A Study of Junior House Officers,” Academic Medicine, 74, no. 11, 1242–1248.Google Scholar
Northouse, L.L. Northouse, P.G., Health Communication: Strategies for Health Professionals, 3rd ed. (Stamford, CT: Appleton & Lange, 1998).Google Scholar
For examples of such research, see Hope, T. Fulford, K.W., “The Oxford Practice Skills Project: Teaching Ethics, Law and Communication Skills to Clinical Medical Students,” Journal of Medical Ethics, 20, no. 4 (1994): 229–34; and Parle, M. Maguire, P. Heaven, C., “The Development of a Training Model to Improve Health Professionals' Skills, Self-Efficacy and Outcome Expectancies When Communicating With Cancer Patients,” Social Science & Medicine, 44 (1997): 231–40.CrossRefGoogle Scholar

A correction has been issued for this article:

Erratum