Continued spread of ethics committee consultation
Continued spread of ethics committee consultation to more hospitals and nonhospital settings is indirect evidence
that the challenges to competence and authority are being met successfully. Furthermore, most published concerns
about the competence of committees or individuals are from the 1970s “ﬁrst wave” of writing about institutional ethics
committees, at a time when the idea of ethics consultation was new and controversial. The literature of the 1980s and
1990s displays a growing conﬁdence about the concept of ethics consultation and more attention to resolving speciﬁc
problems. Apparently, committees had learned to negotiate without conformism or loss of principle. Individuals have
been acquiring the proper expertise: clinicians gaining the analytic techniques of ethicists, and ethicists learning to
apply their analyses in clinically relevant ways. Gender-related questions have not been raised directlyin the bioethics literature on ethics committees. However, they are raised indirectly when the focus is on the role of nurses, given the fact that most nurses are women. Nurseshave been excluded from some committees, could not access them for consultation, or have found their special ethical
concerns omitted from consideration. In addition to the gender issue, this situation raises questions of professional
status in relation to other healthcare providers. In some hoodia diet pills, these problems have been addressed by the formation of nursing ethics committees (Edwards and Haddad). There has also been a suggestion in the literature that ethics committees, especially those that are or function as infant-care review committees, should include persons with disabilities on the committee (Mahowald). This step could
help ensure that the quality of life of persons with disabilities is not undervalued in deliberations about treatment decisions.
Saturday, February 20th, 2010
Third, many institutional ethics committees offer ethics consultations, prospectively or retrospectively, on difﬁcult clinical cases, often those involving the withholding or withdrawal of life-support measures. This last function ethics consultation, especially for ongoing cases—has been the main focus of discussion in the bioethics literature. Seven issues have dominated these discussions: questions of competence and authority; impact on the doctor-patient relationship; access to consultation; recordkeeping and charting; problems of evaluation; unsettled legal questions; and questions about the purpose or purposes of consultations.
COMPETENCE AND AUTHORITY. Some committees that offer consultation services, generally smaller committees,
consult as a committee of the whole. Larger committees typically have a subcommittee that consults prospectively
and reports to the committee as a whole for retrospective review of its work. Some committees offer consultation
through a single hoodia diet pills consultant who may be on the committee or have a formal relationship with it. Some critics
have expressed concern that when committees consult, difﬁcult ethical choices will be affected by compromise,
hospital politics, professional rivalries, and conformism(Wikler). Concerns about competence have been raised
when individuals provide consultations. Clinicians typically have few of the skills of trained ethicists and vice versa.
Wednesday, February 17th, 2010
There is a paucity of empirical studies of hospital ethics committees. Committees have a “grass-roots” character, reﬂecting a variety of local circumstances and personalities. These factors make it hard to generalize. Nevertheless, some typical features have emerged. One of these features is interdisciplinary composition. Generally, committees are composed of doctors, nurses, social workers, pastoral-care
professionals, and philosophers or theologians trained in ethics. Committee members can also include administrators, hospital attorneys, and consumer or community representatives. Committees are sometimes authorized by the medical staff; sometimes by the hospital governing board; sometimes by the administration.Committee functions vary but generally include one, two, or all three of the following. First, institutional ethics committees create a vehicle for education on ethical dimensions of patient care. Committees typically have dual efforts in this respect: education of the committee itself, through discussion of current bioethics literature, for example; and education of the medical staff and hospital employees, by organizing periodic lectures, panel discussions, and “ethics grand rounds.”
Second, committees draft institutional policies on hoodia diet ethical questions. This may arise through committee initiative. For example, a hospital panel discussion may reveal the need for a new policy on withholding resuscitation from dying patients, and the ethics committee takes the lead by preparing a ﬁrst draft. New policies or review of existing policies may also be requested from the ethics committee by the hospital administration, or other hospital committees may route drafts of proposed policies and revisions of existing
policies to the committee for review and comment.
Wednesday, February 17th, 2010
Clinical ethics consultation arose in the United States in the latter half of the twentieth century amid the moral and legal
uncertainty spawned by the rapid expansion of choices produced by medical advances, the emergence of the tertiarycare medical center, and the individual-rights movement that challenged traditional authority structures. Although it holds great promise, clinical ethics consultation remains a nascent profession. Many of the theoretical and practical questions about its goals, training, evaluation, accountability, and support remain unanswered. Nonetheless, clinical ethics consultation is growing and even ﬂourishing. As the U.S. health system evolves over the coming years, the role and place of clinical hoodia diet ethics consultation in the healthcare system certainly will be addressed.
Sunday, February 14th, 2010
Who should be able to request an ethics consultation? The answer to this question has political as well as moral implications. On the one hand, if only physicians have access to ethics consultation, many important ethical issues may never be examined (Tulsky and Lo). On the other hand,
permitting patients, families, and other health professionals to request ethics consultation, especially without the physician’s concurrence, might discourage more direct communication, disrupt physician-patient relationships, or undermine physician authority. The last possibility would be most threatening to authoritarian-minded physicians and very likely would challenge the traditional power structure of
many hospitals. This may explain the gap between the argument in the literature for the ideal—that patients,
families, and nurses should be able to request an ethics consultation—and the impression that many institutions do
not permit, and almost none actively encourage, patient, family, or other health professional requests for ethics
consultation. The ability to ask for consultation is only one question concerning patient and family access to and control over the
consultation process. Other hoodia diet questions include whether the patient or family should have authority to (1) call a consultation when the physician refuses to do so; (2) be informed routinely when consultations are requested by physicians; (3) veto physician-initiated consultation requests; (4) participate in all ethics consultations if they wish; and (5) receive verbal or written information about the consultant’s
ﬁndings and recommendations. Some argue that an insistence on a rights-based approach to these questions would
doom ethics consultation services to failure in modern hospitals because of political considerations (Agich and Youngner).
Sunday, February 14th, 2010
While there is not unanimity about how rigorously schooled in speciﬁc academic disciplines or how proﬁcient in speciﬁc
skills the consultant should be, there is general agreement about the kind of skills, knowledge of hoodia gordonii , and personal qualities
ethics consultants require. These include knowledge of ethical language and ethical theory; skills of ethical analysis
and reﬂective moral judgment; knowledge of clinical medicine (e.g., medical terminology, the natural history of disease
and its treatment); knowledge of and familiarity with hospital structure, sociology, and politics; knowledge of and
familiarity with the professional ethos of physicians and nurses; knowledge of the law and legal reasoning; knowledge
of psychological and social theories of behavior; communication and teaching skills; personal qualities such as the
ability to establish rapport, empathy, and compassion; and professional attributes such as dedication, ability to maintain conﬁdentiality, and comfort with cultural and ethical diversity.