Evaluating Ethics Committees

Abstract

Are ethics committees doing good? If so, how do they accomplish this and who benefits from their efforts? effects have they on the individuals and institutions they serve? Since ethics committees have been part of the health care system for more than a decade, the time has come to consider ways of evaluating their effectiveness. Committees in our network have been developing various approaches to self-assessment Most ethics committees perform several functions-typically, education, policy development and case consultation. Their performance in each of these areas must be evaluated to determine where committees are most and least effective. This information can then be used to plan future activities so as to achieve greater overall impact. Selective evaluation according to function, however, may produce a skewed picture; assessment of overall performance is also necessary. We believe that retrospective review, a fourth function of these committees, can provide ongoing evaluation of committee operations as a whole. Retrospective review involves looking back over completed cases in which ethically difficult patient care situations are identified to determine whether more staff or patient education is needed and whether institutional policies and case consultation procedures are adequate and used. It seems logical to assume that the mission statement of an ethics committee will provide some basis for measuring committee performance in retrospect-at the very least, for determining whether a committee is meeting the expectations of its founders. If the mission statement does not provide a basis for developing evaluation criteria, it may be too vague, unrealistic, or inappropriate. We reviewed the mission statements of nine ethics committees in our area. All indicated that they were to be a forum, which several further defined as a place where staff could come to discuss ethical issues, dilemmas, and concerns. One committee's statement contained two specific goals for its members: To come to an awareness of the divergent value systems which influence choices people make and To learn to think effectively and dialogue meaningfully with each other as we come to decisions. These goals are detailed enough to allow members and researchers to develop a survey tool by which to measure desired process and outcome achievements. The next step would be to create some means of showing how increased awareness of different values, effective thinking, and significant interchanges benefit the institution and those whom it serves-a challenging task. One approach to determining the effectiveness of a committee as a forum is to measure meaningful dialogue, or the absence of it. We have observed that in those committees where discussion is dominated by a few individuals, there does not seem to be a feeling of openness. Perhaps committee chairpersons could note the degree of participation by individual members in deliberations and prepare a dialogue ratio or some such measure of discussion, as one index of forum achievement. We also solicited evaluation measures indirectly from members of ethics committees in our network by asking them how they would respond to the following question: What has your committee accomplished? …