Strangers at the bedside Flashcards
what is the earliest citation for the start of ethics committees?
1975
what is the Hastings Center Report? when was it?
1977 - 3 reviews of ethics committees
what was the Baby Doe rules? when was it?
1984 - establishment of infant care review committees which promoted the growth of hospital ethics committees
what is JAHCO? what did it do? when?
1992 - launched mandate that hospitals establish a mechanism for hospital personnel to consider and educate its constituents on ethical issues in healthcare
what are the roles of ethics committees?
- 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
what are the underlying goals of ethics committees?
- 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)
ethics committees ARE:
- about assuring that ethics issues are identified, raised, and discussed
- about assuring that a patient’s desires are heard and honored
- about group “grope”
ethics committees are NOT:
- 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
members of the ethics committee usually include:
- 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)
ethics committees should limit activities to the level of _____
expertise available
do ethics committees / consultants make clinical decisions?
NO - they provide ethical options / advice / resources
what are the 3 core competencies for health care ethics consultation?
- ethical assessment skills
- process skills
- interpersonal skills
what are ethical assessment skills health care ethics consultation?
- 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
what are the process skills health care ethics consultation?
- 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
what are the interpersonal skills health care ethics consultation?
- 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
what makes up the majority of issues that come to ethics committees?
communication issues
what are the two types of work that ethics committees deal with?
- clinical issues
- organizational ethics
what is the difference between an ethics consultant and an ethics subcommittee?
ethics consultant: expert in clinical ethics who provides either ethics consultation services or serves as an educational consultant to the ethics committee
what are the pros and cons of an ethics consultant?
pros - recognized expert, logistics is straight forward
cons - clinicians may depend upon this person exclusively and not develop own expertise, only one voice
what are the pros and cons of an ethics subcommittee?
pros - structure incorporates diversity of views
cons - difficulty organizing the consultation process, may lack sufficient expertise
who can request an ethics consultation?
in most clinical settings anyone may request an ethics consultation - patient, family, healthcare member
what represents the changing pattern of issues in hospital ethics committee consultations?
FROM moral dilemmas TO moral moral distress and moral dissonance
definition: moral dilemma
- a situation involving choice between equally (un)satisfactory alternatives
- a problem seemingly incapable of a satisfactory solution
definition: moral distress
- 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”
definition: moral dissonance
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
what are the intrapersonal elements of moral distress?
- distress
- powerlessness
- fear
what are the components and roles of integrated ethics?
- ethics consultation: decisions and actions
- preventative ethics: systems and processes
- ethics leadership: environment and culture
