Functions and Outcomes of a Clinical Medical Ethics Committee: A Review of 100 Consults

Abstract

Established in 1997, Summa Health System's Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been unclear. This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133-62); (2) changes in top two reasons for EC consult requests from 'Family opposed to withdrawing life-sustaining treatment (LST)’ and 'Patient capacity in question' to 'Futility' and 'Physician opposed to providing LST'; (3) changes in top two recommendations given by the EC from 'Emotional Support for Patient/Family' and 'Initiate DNR Order' to 'Comfort Care' and 'Withdraw Treatment.' Overall, 88% of recommendations were followed. PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined.