Healthcare Ethics Committees Research Articles

Responsive Yet Independent: Fixing the Corruption of Hospital Ethics Committees

This is a research proposal for a project to be completed during a part-time Non-Residential Lab Fellowship from the Edmond J. Safra Center for Ethics. The term of the project would be between September 2013 and June 2014.Complex ethical situations, such as end-of-life medical treatment disputes, occur on a regular basis in healthcare settings. Healthcare ethics committees (HECs) have been the dispute resolution forum for many of these conflicts. HECs are typically multidisciplinary groups comprised of representatives from different departments of the healthcare facility: medicine, nursing, law, pastoral care, and social work, for example. HECs were established to support and advise patients, families, and caregivers as they work together to find solutions for delicate circumstances.HECs generally have been considered to play a mere advisory, facilitative role. But, in fact, HECs often serve a decision making role. Both in law and practice HECs increasingly have been given significant authority and responsibility to make treatment decisions. Sometimes, HECs make decisions on behalf of incapacitated patients with no friends or family. Other times, HECs adjudicate disputes between providers and the patient or patient’s family.Unfortunately, HECs are not up to the task. They lack the necessary independence, diversity, composition, training, and resources. HECs are overwhelmingly intramural bodies. That is, they are comprised of professionals employed directly or indirectly by the very same institution whose decision the HEC adjudicates. Consequently, many HECs make decisions that suffer from risks of corruption, bias, carelessness, and arbitrariness.To address the problems of intramural HECs, I propose that their adjudicatory authority be relocated to a multi-institutional HEC. Thereby, no single institution’s HEC would have a controlling voice in the adjudication of its own dispute. A multi-institutional HEC preserves the expertise and extrajudicial nature of HECs. But in contrast to an intramural HEC, a multi-institutional HEC possesses better resources, a greater diversity of perspectives, and the neutrality and independence required by due process.

MORAL DISTRESS IN IRANIAN NURSES' EXPERIENCES

Abstract Background & Aim: Ethics is an integral part of nursing practice. Nurses and other professional caregivers are increasingly recognizing the issue of moral distress. The aim of this study is to describe Iranian nurses' experiences in moral distress. Materials and Method : In this study the qualitative phenomenological approach was used. 11 nurses from teaching hospitals of Hamadan University of Medical Sciences participated in the study. The data were collected by in-depth interviews. Transcripts were analysed by constant comparative contant analysis. Result: The results sorted into 4 content areas: individual characteristics of team care (including knowledge, ability, experience, responsibility and…), mental-affective reactions (including faulty, defensive reactions, lack of motivation and…), laws and officials (including, limitation of laws and contradictory of laws with ethics, religion, knowledge and ability) and circumstances of workplace (including physical circumstances, manpower, facilities and equipments). Conclusion: It is necessary that nurses become familiar with ethical problems, nursing code of ethics and promote the skills for encounter to moral distress. Key words: Ethics, Moral distress, Nursing practice, Experience, Phenomenology Corresponding Author: Parkhideh Hasani, Faculty Lecturer, Department of Anesthesiology, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences,Tehran, Iran Email: p_hasani@sbmu.ac.ir REFERENCES - Forum. 17 (1) 33–48. - - - - - - - - - - - - - - - - - - - edition. Philadelphia: Lippincott. - Wilkinson JM (1987). Moral distress in nursing practice: Experience and effect. Nursing Forum. 23(1) 16-29. Streubert HJ Carpenter DR (2007). Qualitative Research in Nursing Advancing the Humanistic Imperative. 3 rd Van Manen M (2001). Researching Lived Experience. Action Sensitive Pedagogy 3 rd edition. Ontario: Althouse Press. Silen Marit et al (2008). Workplace distress and ethical dilemmas in neuroscience nursing. Journal of Neuroscience Nursing. 40(4) 222-231. Pijl-Zieber EM et al (2008 ) . Moral distress: An emerging problem for nurses in long-term care. Quality in Ageing and Older Adults. 9(2) 39- 48. Oskouie F pairovi H (2005). [Qualitative Research in Nursing]. 1 st edition. Tehran: Iran University of Medical Sciences Press. (Persian). Oberle k Hughes D (2001). Doctors and nurses perceptions of ethical problems in end-of-life decisions. Journal of Advanced Nursing. 33(6) 707-715. Nathaniel A (2002). Ethics and human rights. The American Nurses Association Issues Update. 1(2) 3-8. Mitchell GJ (2002). Policy, procedure and routine: Masters of moral influence. Nursing Science Quarterly. 14(2) 109- 114 McVicar A (2003). Workplace stress in nursing: A Literature review. Journal of Advanced Nursing. 44(6) 633-642. Mauleon AL Palo Bengtsson L Ekman SL (2005). Anaesthesia care of older patients as experienced by nurse anaesthetists. Nursing Ethics. 12(3) 263–272. Herting A et al (2004). Downsizing and reorganization: Demands, challenges and ambiguity for registered nurses. Journal of Advanced Nursing. 45(2) 145-154. Jameton A (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. AWONN’s Clinical Issues in Prenatal and Women Health Nursing. 4(4) 542-551. Gutierrez KM (2005). Critical care nurses’ perceptions of and responses to moral distress. Dimensions of Critical Care Nursing. 24(5) 229–241. Chitty Kay K Beth BP (2007). Professional Nursing Concepts. Challenge. Saunders Elsevier Ebrahimi H et al (2007). [Stress: Major reaction of nurses to the context of ethical decision making]. Journal of Iran University of Medical Sciences. 14(54) 7-15 (Persian). Cronqvist A Lutzen K Nystrom M (2006). Nurses’ lived experience of moral stress support in the intensive care context. Journal of Nursing Management. 14(5) 405-413. Corley M et al (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing. 33(2) 250-256. Corley M (2002). Moral distress: A proposed theory and research agenda. Nursing Ethics. 9 (6) 636-650. Canadian Nursing Association (2002). Code of ethics for registered nurses. Ottawa: Author. [On line]. http://www.nurses.ab.ca/Carna-Admin/Uploads/CNAcodeofEthics.pdf Canadian Nurses Association (2003). Ethics in Practice for Registered Nurses. [On line]. http://www2.cnaaiic. ca/CNA/documents/pdf/publication/Ethics_in_Practice. Austin W et al (2005). Moral distress in healthcare practice: the situation of nurses. Health care ethics committee

La bioética comisionada revisitada

<p>El artículo propone reconocer la importancia que tiene para la consolidación de la bioética como un campo de conocimiento e intervención, la trayectoria que por diversas vías ha tenido la llamada bioética comisionada. Se enfatizan las condiciones históricas que condujeron a la creación de comités de ética hospitalaria y de la investigación, lo que posteriormente conducirá a la creación de comités, concejos o comisiones nacionales e internacionales. Se resaltan los aportes que esa bioética comisionada tiene para el desarrollo legislativo, el trazado de políticas, la construcción de una cultura deliberante e informada públicamente, la bioética comisionada como un movimiento de reforma social.</p>

Are Ethics Committees in Tune With the “Epidemiology of Ethical Issues”?

Are Ethics Committees in Tune With the “Epidemiology of Ethical Issues”?

Bioethics in Mediterranean culture: the Spanish experience

This article presents a view of bioethics in the Spanish context. We may identify several features common to Mediterranean countries because of their relatively similar social organisation. Each country has its own distinguishing features but we would point two aspects which are of particular interest: the Mediterranean view of autonomy and the importance of Catholicism in Mediterranean culture. The Spanish experience on bioethics field has been marked by these elements, trying to build a civic ethics alternative, with the law as an important support. So, Spanish bioethics has been developed in two parallel levels: in the academic and policy maker field (University and Parliament) and in clinical practice (hospitals and healthcare ethics committees), with different paces and methods. One of the most important changes in the paternalistic mentality has been promoted through the recognition by law of the patient's rights and also through the new generation of citizens, clearly aware on the exercise of autonomy. Now, the healthcare professionals have a new challenge: adapt their practice to this new paradigm.

Emotions and Ethical Considerations of Women Undergoing IVF-Treatments

Women who suffer from fertility issues often use in vitro fertilization (IVF) to realize their wish to have children. However, IVF has its own set of strict administration rules that leave the women physically and emotionally exhausted. Feeling alienated and frustrated, many IVF users turn to internet IVF-centered forums to share their stories and to find information and support. Based on the observation of Dutch and Greek IVF forums and a selection of 109 questionnaires from Dutch and Greek IVF forum users, we investigate the reasons why users of IVF participate in online communities centered on IVF, their need for emotional expression and support, and how they experience and use the information and support they receive through their participation in the online community. We argue that the emotional concerns expressed in such forums should be taken into account by health care ethics committees for IVF-related matters in order to promote more patient-oriented care and support for women going through IVF.

Legal Briefing: Healthcare Ethics Committees

This issue’s “Legal Briefing” column covers recent legal developments involving institutional healthcare ethics committees. This topic has been the subject of recent articles in JCE. Healthcare ethics committees have also recently been the subject of significant public policy attention. Disturbingly, Bobby Schindler and others have described ethics committees as “death panels.” But most of the recent attention has been positive. Over the past several months, legislatures and courts have expanded the use of ethics committees and clarified their roles concerning both end-of-life treatment and other issues. These developments are usefully grouped into the following eight categories: 1. Existence and availability 2. Membership and composition 3. Operating procedures 4. Advisory roles 5. Decision-making and gate-keeping roles 6. Confidentiality 7. Immunity 8. Litigation and court cases

Assessing Physicians’ Roles on Health Care Ethics Committees

The purpose of this study was to examine the role of physicians on HEC including structural and process features. Four committees were selected from among 12 volunteering to participate with 12 sessions observed. Power analysis (0.8) confirmed an adequate number of communication exchanges, and no statistical significant difference (p < 0.05) among two prior surveys affirmed the sample. Data collection included established questionnaires and communication analyses with a tested method. Results revealed physician presence was robust and similar to prior reports on HEC structure; however, physicians rated their role effectiveness lower than other occupations and lower than overall committee effectiveness. Communication exchanges representing process revealed three positive communication types, and consistent attempts to aid committee functions through consensual processes that also were substantiated by non-physician members. Findings suggested more attention to both structural and process functions of HEC and their members.

Introduction: HEC Forum Special Issue on Privacy and Commodification

The papers in this special thematic issue of HEC Forum critically and carefully explore key issues at the intersection of patient privacy and commodification. For example, should hospitals be required to secure a person's consent to any possible uses to which his discarded body parts might be put after his treatment or should it only be concerned with securing his informed consent to his treatment? Should a hospital be required to raise the possibility of the commodification of such (patient-discarded) body parts, or should it only be required to address this issue if the patient asks about it? Should persons be paid to engage in medical research, or should they only be compensated for their time, on the grounds, perhaps, that such payment would be coercive or exploitative, for it might move some persons to agree to participate in research who otherwise would not have done? This number of HEC Forum illustrates the widespread implications of these issues upon which healthcare ethics committees are called to deliberate.

Commentary: Mrs. J—Culture and Healthcare Ethics Committees

The heart-rending story of Mrs. J raises many complex ethical issues. Key elements include suffering, disagreement, culture, religion, perspective, and facts. Overarching concerns include whose voices and stories should count, the connection of pain with suffering, and how healthcare ethics committees should respond.

Healthcare ethics: The experience after the Haitian earthquake

On January 12, 2010, a 7.0 Richter earthquake devastated Haiti and its public health infrastructure leading to a worldwide humanitarian effort. The United States sent forces to Haiti's assistance including the USNS Comfort, a tertiary care medical center on board a ship. Besides setting a transparent triage and medical regulating system, the leadership on the Comfort instituted a multidisciplinary Healthcare Ethics Committee to assist in delivering the highest level efficient care to the largest number of victims. Allocation of resources was based on time-honored ethics principles, the concept of mass casualty triage in the setting of resource constraints, and constructs developed by the host nation's Ministry of Health. In offering aid in austere circumstances, healthcare practitioners must not only adhere to the basic healthcare ethics principles but also practice respect for communities, cultures, and traditions, as well as demonstrate respect for the sovereignty of the host nation. The principles outlined herein should serve as guidance for future disaster relief missions. This work is in accordance with BUMEDINST 6010.25, Establishment of Healthcare Ethics Committees.

Ethical aspects of living-donor kidney transplantation

Living donor kidney transplantation is considered an established treatment for end-stage renal failure and is accepted in different transplant forums, nationally and internationally, while ensuring the safety of the donation, the information, the motivation and caring, the free consent and the absence profit. the living donor nephrectomy is not extent of risks so a good assessment of the donor's health status and psychosocial situation must be performed to evaluate if the benefits to donor and recipient outweigh the risks assumed. Information and Consent: to be considered ethically acceptable, the donor must be able to give his free consent to the donation after understanding the information provided, accepting the risks and benefits of organ donation, knowing the treatment alternatives for the recipient and the long-term consequences of his decision The absence of profit: offering or receiving money for an organ or other human tissue violates the principles of justice and equity and it is considered ethically and legally unacceptable it is important to make a good psychosocial assessment to identify whether the motivation is altruistic or not and, in other terms, to detect any kind of coercion (ex, in the family). Living donation must not be offered in desperate family situations so it is important to assess family relationships to rule out the absence of freedom in donor's choice.The Role of Health Care Ethics Committees: there exists a normative in our country that regulates living donation and establishes that the hospital ethics committees should participate in the process of living donation in all cases. Their job is to assess the process and develop a report on the donor free consent to donation. The responsible person of the living transplant program should provide the documentation necessary to the committee. An interview with the potential donor can be required in some cases.

Clinical Ethics as Liaison Service: Concepts and Experiences in Collaboration with Operative Medicine

Over the past decade, clinical ethics has received growing attention in Germany as in most European countries. In the mid-1990s, most European countries made efforts to establish healthcare ethics committees (HEC) and clinical ethics consultation (CEC) services. The development of clinical ethics discourse and activities in Germany, however, was delayed and, consequently, is still in its natal phase. Until the end of the 1990s, the only institutionalized bodies of ethical reflection were the research ethics committees at university medical centers and at the State Physician Chambers. In March 1997, the Catholic and Protestant hospital association in Germany recommended the implementation of HECs, modeled after the American HECs. Consequently, the establishment of clinical ethics consultation in the form of HECs started in Germany in denominational hospitals, followed by a small but increasing number of community hospitals.

Credentials for Clinical Ethics Consultation – Are We There Yet?

_____________________________________________________________________________________ Anita J. Tarzian, Ph.D., RN, Ethics & Research Consultant, Baltimore, MD, Program Coordinator, Maryland Health Care Ethics Committee Network at the University of Maryland School of Law, 500 W. Baltimore St., Baltimore, MD 21201; email: atarzian@law.umaryland.edu, atarzian@comcast.net. Credentials for Clinical Ethics Consultation – Are We There Yet?

Creating a National Infrastructure for Good Clinical Practice in Clinical Trials in Ukraine

This article examines the current Ukrainian approach to creating a national infrastructure for medicines advancement and human subjects protection through clinical trials based on good clinical practice (GCP). It explores the roles of the government, the healthcare society, ethics committees and industry in contributing to the development of a national infrastructure that contributes to national needs in health research as well as the global development of medicines.

Klinik: Aufgaben und Kriterien für Klinische Ethikkomitees

This article provides a review on health care ethics committees and clinical ethics consultation in Germany. After a definition of these new institutions in the German health care system, detailed information on development, structures, implementation process and tasks of health care committees is provided. The three main tasks of health care ethics committees, clinical ethics consultation, development of ethical guidelines, and teaching and continuing medical education in clinical ethics are reported. Finally the author discusses the current professionalization and likely future developments of the field.

Enriching Our Views on Clinical Ethics: Results of a Qualitative Study of the Moral Psychology of Healthcare Ethics Committee Members

The contribution of healthcare ethics committee (HEC) members to HECs is fundamental. However, little is known about how HEC members view clinical ethics. We report results from a qualitative study of the moral psychology of HEC members. We found that contrary to the existing Kohlberg-based studies, HEC members hold a pragmatic non-expert view of clinical ethics based mainly on respect for persons and a commitment to the patient’s good. In general, HEC members hold deflationary views regarding moral theory. Ethical principles are not abstract foundations but the expression of moral commitments to patients that pre-exist awareness of moral theory. Emotions and proximity to patient sufferance fundamentally shape the views of HEC members on clinical ethics. Further work at the intersection of clinical ethics and qualitative research could bring to the foreground lay perspectives on moral problems that may differ from bioethics expert views.

Ethikberatung im Krankenhaus

The number of healthcare ethics committees has not only increased but has also widely differentiated. The tasks of healthcare ethics committees, their different types, the implementation process and the role of pastors are discussed. Unanswered open questions remain concerning the evaluation, the methodology of ethics counselling and the issues as regards content.

Handbook for health care ethics committees

Handbook for health care ethics committees

Medical humanities and philosophy of medicine

Medical humanities and philosophy of medicine