Strangers at the bedside

Question 1

what is the earliest citation for the start of ethics committees?

Answer 1

1975

Question 2

what is the Hastings Center Report? when was it?

Answer 2

1977 - 3 reviews of ethics committees

Question 3

what was the Baby Doe rules? when was it?

Answer 3

1984 - establishment of infant care review committees which promoted the growth of hospital ethics committees

Question 4

what is JAHCO? what did it do? when?

Answer 4

1992 - launched mandate that hospitals establish a mechanism for hospital personnel to consider and educate its constituents on ethical issues in healthcare

Question 5

what are the roles of ethics committees?

Answer 5

• review of treatment decisions made on behalf of non-decisional, terminally ill patients
• review of medical decisions in cases of disagreement to refer to court with proper jurisdiction
• counseling: social, psychological, spiritual
• establishing guidelines regarding treatment / decisions
• sponsoring or conducting educational programs

Question 6

what are the underlying goals of ethics committees?

Answer 6

• promote rights of patients (BENEFICENCE)
• promote shared decision making
• promote fair policies and procedures (JUSTICE) that maximize likelihood of achieving good, patient-centered outcomes (BENEFICENCE)
• enhance ethical tenor of health care professionals (virtue)

Question 7

ethics committees ARE:

Answer 7

• about assuring that ethics issues are identified, raised, and discussed
• about assuring that a patient’s desires are heard and honored
• about group “grope”

Question 8

ethics committees are NOT:

Answer 8

• about developing an advocacy model
• about Solomon-like wisdom to pick who is right
• about funding ethics experts
• about the good opinions of nice well intentioned people

Question 9

members of the ethics committee usually include:

Answer 9

• clinician / social worker / spiritual care counselor
• at least one person with advanced ethics degree
• quality improvement manager
• representative from education department
• community representative(s)
• lawyer (not for the institution)

Question 10

ethics committees should limit activities to the level of _____

Answer 10

expertise available

Question 11

do ethics committees / consultants make clinical decisions?

Answer 11

NO - they provide ethical options / advice / resources

Question 12

what are the 3 core competencies for health care ethics consultation?

Answer 12

• ethical assessment skills
• process skills
• interpersonal skills

Question 13

what are ethical assessment skills health care ethics consultation?

Answer 13

• discern and gather relevant data
• assess the social and interpersonal dynamics
• distinguish the ethical dimensions of the case from other often overlapping dimensions
• identify various assumptions
• identify relevant values of involved parties

Question 14

what are the process skills health care ethics consultation?

Answer 14

• identify key decision makers
• set ground rules for formal meetings
• express and stay within the limits of the role of ethics consultation
• create an atmosphere of trust that respects priacy and confidentiality

Question 15

what are the interpersonal skills health care ethics consultation?

Answer 15

• listen well and communicate interest, respect, support, empathy
• educate involved parties - ethical dimensions
• elicit the moral view of involved parties
• represent the views of involved parties to others
• enable involved parties to communicate effectively and to be heard by others
• recognize and attend to relational barriers to communication

Question 16

what makes up the majority of issues that come to ethics committees?

Answer 16

communication issues

Question 17

what are the two types of work that ethics committees deal with?

Answer 17

• clinical issues

- organizational ethics

Question 18

what is the difference between an ethics consultant and an ethics subcommittee?

Answer 18

ethics consultant: expert in clinical ethics who provides either ethics consultation services or serves as an educational consultant to the ethics committee

Question 19

what are the pros and cons of an ethics consultant?

Answer 19

pros - recognized expert, logistics is straight forward

cons - clinicians may depend upon this person exclusively and not develop own expertise, only one voice

Question 20

what are the pros and cons of an ethics subcommittee?

Answer 20

pros - structure incorporates diversity of views

cons - difficulty organizing the consultation process, may lack sufficient expertise

Question 21

who can request an ethics consultation?

Answer 21

in most clinical settings anyone may request an ethics consultation - patient, family, healthcare member

Question 22

what represents the changing pattern of issues in hospital ethics committee consultations?

Answer 22

FROM moral dilemmas TO moral moral distress and moral dissonance

Question 23

definition: moral dilemma

Answer 23

• a situation involving choice between equally (un)satisfactory alternatives
• a problem seemingly incapable of a satisfactory solution

Question 24

definition: moral distress

Answer 24

• painful feelings and / or
• psychological disequilibria caused by a situation in which 1) one believes one knows the ethically ideal action to take and 2) that one cannot carry out that action because of institutional obstacles

“you think you know but you can’t do anything about it”

Question 25

definition: moral dissonance

Answer 25

a clash or inconsistency between the beliefs and values of the parties to the decision making process

ex: differing religious belief systems at odds with treatment

Question 26

what are the intrapersonal elements of moral distress?

Answer 26

• distress
• powerlessness
• fear

Question 27

what are the components and roles of integrated ethics?

Answer 27

• ethics consultation: decisions and actions
• preventative ethics: systems and processes
• ethics leadership: environment and culture