Composition Of Ethics Committees Research Articles

The use of an online comment system in clinical ethics consultation

ABSTRACTBackground: Although a mechanism for resolving ethical issues in patient care is required for accreditation of American hospitals, there are no formal qualifications for providing clinical ethics consultation (CEC), and there remains great variability in the composition of ethics committees and consult services. Consequently, the quality of CEC also varies depending on the qualifications of those performing CEC services and the format of CEC utilized at an institution. Our institution implemented an online CEC comment system to build upon existing practices to promote consistency and broad consensus in CEC services and enable quality assurance. Methods: This qualitative study explored the use of an online comment system in ethics consultation and its impact on consensus building and quality assurance. All adult ethics consultations recorded between January 2011 and May 2015 (n = 159) were analyzed for themes using both open and directed coding methods. Results: We found that comments broadly reflected three categories: expressions of approval/agreement (87% of consults), comments about the case (89%), and comments about the written record (72%). More than one-third of consults included responses to other comments (37%). The most common types of “comments about the case” included requests for additional information (36%), recommendations for additional services (21%), and references to formal policies/standards (28%). Comments often spanned multiple categories and themes. Comments about the written record emphasized accessibility, clarity, and specificity in ethics consultation communication. Conclusions: We find the online system allows for broad committee participation in consultations and helps improve the quality of CEC provided by allowing for substantive discussion and consensus building. Further, we find the use of an online comment system and subsequent records can serve as an educational tool for students, trainees, and ethics committee members.

Harmonisation of ethics committees' practice in 10 European countries

Background:The Directive 2001/20/EC was an important first step towards consistency in the requirements and processes for clinical trials across Europe. However, by applying the same rules to all types of...

Ethics Committees in the Rural Midwest: Exploring the Impact of HIPAA

Confidentiality of personal health information is an ethical principle and a legislated mandate; however, the impact of the Health Insurance Portability and Accountability Act (HIPAA) on ethics committees ethics committees is limited. This study investigates the prevalence, activity, and composition of ethics committees located in rural central and southern Illinois. Additionally, the impact of the HIPAA Officer serving on the committee is reported. Surveys were mailed to the "Administrator or Ethics Committee Chairperson" at rural Illinois hospitals and skilled care facilities. Survey items included committee composition and perception of HIPAA-related involvement. Over one third (36.7%) of the facilities reported having formal ethics committees. Hospitals were more likely (79.3%) to have ethics committees than skilled nursing facilities (20.7%). Ethics committee members usually include an administrator, nurse, and physician. The smaller the facility (based on number of beds), the more likely it was to have a HIPAA Officer on the committee. Committees with a HIPAA Officer were more likely to be involved in monitoring and/or remediation of HIPAA privacy and security violations. Most respondents, however, did not feel the committee should be involved in these issues. Although the sample size is too small to generalize, HIPAA does seem to have an effect on the issues discussed by ethics committees. Furthermore, ethics committees that include a HIPAA Officer in the membership report increased committee involvement in HIPAA related issues.

Methodologic and ethical ramifications of sex and gender differences in public health research

Experience and investigative studies have shown that inequalities still exist between the sexes as well as in how public health policies and strategies approach the needs of the sexes. Sufficient attention has not been given to gender in public health research. Gender-based differences and similarities need to be promoted, and more structured guidelines are needed to build gender into public health research models. The aim of this review was to investigate and discuss public health research and to answer several related questions on gender biases, ethics and methodologies, and the establishment of guidelines. Using the search terms public health research and gender , or ethics , gender , and public health, a literature search was conducted predominately with, but not limited to, the PubMed database. English- or German-language articles were identified that examined the current status of gender in public health research as well as any relevant ethical guidelines. A review of the current literature showed that much work has been undertaken to promote the inclusion of gender in health research. However, deficiencies in the extent of gender-oriented research have been found in a number of key areas, including ethics committees and public health research methodology. Women were found to be underrepresented in ethics committees, which lack clear guidance, particularly in the European Union, to ensure the inclusion of gender issues in public health research. Data are often not sex disaggregated, and information on gender and social circumstances are frequently lacking. Furthermore, some methodologies, such as those used in the field of occupational health, underestimate men's or women's burden of disease. Recommendations include establishing guidelines for researchers on how to incorporate gender in health research, ensuring that the composition of ethics committees is more representative of society, and recommending that data collection systems or bodies ensure that data are disaggregated by sex and include socioeconomic aspects.

Inclusion of women in cardiac research: Current trends and need for reassessment

Background: Experience and investigative studies have shown that inequalities still exist between the sexes as well as in how public health policies and strategies approach the needs of the sexes. Sufficient attention has not been given to gender in public health research. Gender-based differences and similarities need to be promoted, and more structured guidelines are needed to build gender into public health research models.Objective: The aim of this review was to investigate and discuss public health research and to answer several related questions on gender biases, ethics and methodologies, and the establishment of guidelines.Methods: Using the search terms public health research and gender , or ethics , gender , and public health, a literature search was conducted predominately with, but not limited to, the PubMed database. English- or German-language articles were identified that examined the current status of gender in public health research as well as any relevant ethical guidelines.Results: A review of the current literature showed that much work has been undertaken to promote the inclusion of gender in health research. However, deficiencies in the extent of gender-oriented research have been found in a number of key areas, including ethics committees and public health research methodology. Women were found to be underrepresented in ethics committees, which lack clear guidance, particularly in the European Union, to ensure the inclusion of gender issues in public health research. Data are often not sex disaggregated, and information on gender and social circumstances are frequently lacking. Furthermore, some methodologies, such as those used in the field of occupational health, underestimate men's or women's burden of disease.Conclusions: Recommendations include establishing guidelines for researchers on how to incorporate gender in health research, ensuring that the composition of ethics committees is more representative of society, and recommending that data collection systems or bodies ensure that data are disaggregated by sex and include socioeconomic aspects.

Ethics committees in state mental hospitals: a national survey.

The goals of the study were to examine the composition, operation, and purpose of ethics committees in state mental hospitals, to determine whether committees were accessible to patients and family members, and to identify frequently addressed ethical issues. In June 1992 a 41-item survey questionnaire was mailed to chief executive officers of 204 state-operated general psychiatric inpatient facilities. Survey items asked about the facility's attributes, composition of the ethics committee, how the committee functioned, and the issues it addressed. A total of 145 facilities from 46 states responded to the survey, for a response rate of 71 percent. Nearly half the facilities had ethics committees, most of which were recently established. Physicians accounted for the plurality of committee membership, followed by nurses and administrators. Although several facilities gave patients access to committee meetings, few patients or their family members actually attended these meetings. Issues such as patients' danger to others, resuscitation policies, and scarce resources were frequently addressed by many committees but were never addressed by others. Although many state mental hospitals have established ethics committees in the past few years, these committees may not meet patients' needs because of inadequate representation by patient advocates and family members. Numerous concerns were heard by committees, but no obvious patterns of pressing issues were revealed.

Ethics Committees in Nursing Homes: Applying the Hospital Experience

Ethics Committees in Nursing Homes: Applying the Hospital Experience The need to develop effective methods for addressing ethical issues in clinical care is even greater in nursing homes than acute care hospitals. Institutionalization in itself raises a basic concern about the privacy and self-determination of long-term care patients. This is heightened by the fact that although 50-70 percent of these residents suffer some impairment of their decisional capacity, many lack legal guardians or involved family members to serve as surrogate decisionmakers. [1] Lack of clarity about the role of aggressive treatment, the comparative frequency with which decisions about the use of potentially life-sustaining treatment must be made, and the minimal presence of physicians in daily care in nursing homes increase the need to create institutional means to respond to the ethical dimensions of patient care in these facilities. Ethics committees, although still rare, are being formed with growing frequency in nursing homes. [2] Discussion of the role and composition of these committees in the literature is based largely on experience in the acute care setting. Ethics committees in hospitals recommend institutional policies, educate participants in the decisionmaking process, consult about ethical dilemmas in individual cases, and provide emotional support for professionals who confront ethical dilemmas in patient care. While both hospitals and long-term care facilities benefit from the policy development function of ethics committees, the relative importance of the remaining functions of ethics committees differs for each. The unique ethical issues that arise in long-term care suggest that a cautious approach should be taken to applying the lessons of the hospital experience to the nursing home when developing ethics committees. There should be a more limited need for ethics committees to review individual cases in nursing homes, since the trajectories of illness there tend to follow a more predictable course and can be more readily foreseen and planned for by residents and staff. Efforts to identify patient preferences can be initiated on admission or in the early months of placement before a crisis erupts. When patients are cognitively impaired at the time of placement, appropriate policies for identifying surrogate decisionmakers can also minimize the need for crisis-based committee review. The high rate of staff turnover in long-term care facilities, in contrast with the greater stability of primary caregivers in the acute care setting, dictates the need for continual emphasis on education in clinical ethics in nursing homes. The educational role of ethics committees, consequently, seems even more important in nursing homes than in hospitals. The function of providing emotional support to professionals also takes on greater significance in the nursing home context. The close relationships that can develop between nursing staff and patients make the emotional impact of ethical conflict even greater in this setting. Further, the frequency with which questions about life-extending care are faced by nursing staff, and the greater involvement of staff in the reactions of families to difficult decisions, make the need to provide emotional support especially pressing in long-term care. The composition of ethics committees in nursing homes should also be somewhat different from that in hospitals. The former should have a substantial number of nursing staff, as well as patients or their representatives. The need for greater nursing representation on committees in long-term care facilities stems from three factors: (1) the more central role of nursing staff in directing patient care; (2) the greater knowledge nurses develop about patients, especially about the values and treatment preferences expressed earlier by patients who have become cognitively impaired; and (3) the greater burden of responsibility nursing staff often bear in meeting facility policies about end-of-life care decisions. …