The Emerging Social Work Role on Hospital Ethics Committees: A Comparison of Social Worker and Chair Perspectives

Abstract

With ever-advancing medical technology involving such life-altering procedures as organ transplants, genetic engineering, and sophisticated life support systems, hospital social workers collaborate with other professional groups regarding ethical dilemmas affecting patients and their families. They assist families in decision making about issues such as whether to discontinue treatment and in clarifying beliefs regarding quality of life. In response to these new medical dilemmas, the Joint Commission on the Accreditation of Healthcare Organizations (Joint Commission), the American Hospital Association, and institutions themselves have mandated that ethical review procedures be developed. The result has been a rapid emergence of hospital ethics committees over the last decade. Ethics committees are multidisciplinary groups of professionals that have been established in hospitals to examine ethical issues (Cranford & Doudera, 1984). Typical membership of ethics committees includes physicians, nurses, administrators, social workers, clergy, attorneys, lay people, and other health care professionals (Ross, 1986). According to Hoffman (1993), their primary purpose is the protection of patients' rights and interests. A wide variety of issues are discussed, such as patients' and families' wishes regarding treatment decisions, organ donation, foregoing treatment in a terminal illness, and various institutional policies regarding these issues. A more recent focus has been to discuss liability regarding outcomes of ethical recommendations made by the committees and carried out by medical professionals. Given social workers' extensive experience with ethical issues in the hospital setting, it is not surprising that a number of scholars have viewed the professional expertise of social workers as essential to hospital ethics committees (Abramson & Black, 1985; Foster, Sharp, Scesny, McLellan, & Cotman, 1993; Furlong, 1986; Gelman, 1986; Reamer, 1985; Silverman, 1992), especially because the main purpose of such committees is congruent with social work values (Csikai, 1995). Thus far the explosive growth of hospital ethics committees has far outpaced empirical efforts to examine their functioning. For instance, Skinner's (1991) national survey found 60 percent of hospitals had such committees, most of which were interdisciplinary. At that time social workers participated on 76 percent of these committees. We would expect both the number of committees and social work's presence to have shown further increase since 1989. Despite, or perhaps because of, this rapid emergence, we know little about the range of responsibilities of such committees, or how tasks are delegated to the varied professional groups involved. More specifically, inasmuch as social workers appear to be major participants on such committees, we need to understand more about this rapidly emerging component of our professional role. Thus far, however, there has been limited examination of social work's role in health care ethical decisions (Silverman, 1992). The work currently available has been focused on common ethical dilemmas facing medical social workers (Foster et al., 1993; Joseph & Conrad, 1989), mainly concerning neonatal and pediatric issues (Ross, 1986; Silverman, 1992). This article examines the arenas of social workers' role on hospital ethics committees as they relate to the expectations of both social workers and their ethics committee chairs. Hospital Ethics Committees and the Social Work Role What are the possible roles for social workers on hospital ethics committees? Ross (1986) suggested that the three main functions of ethics committees are case consultation and review, policy development and review, and education. Case consultation and review assist in resolution of ethical dilemmas as they are happening or retrospectively. In the policy arena, committees review existing policies and examine them for needed changes or formulate new policies based on ethical concerns that may arise in the hospital. …