Ethics Committees and Ethics Consultation

• What does an ethics committee do?
• Who becomes a member of an ethics committee?
• What is the difference between an ethics committee and an ethics consultant?
• Under what circumstances should I use an ethics committee?
• What will the ethics consultant do if I page her or him?
• How do I contact the ethics committee or request an ethics consultation?

Most hospitals are now required to have an ethics committee, and many in the Seattle area provide an ethics consult service. This topic page will discuss the role and activities of these groups.

What does an ethics committee do?

Ethics committees involve groups of individuals from diverse backgrounds who support health care institutions with three major functions: providing ethics consultation, developing and/or revising select policies pertaining to clinical ethics (e.g., advance directives, withholding and withdrawing life-sustaining treatments, informed consent, organ procurement), and facilitating education about topical issues in clinical ethics.

The underlying goals of ethics committees are:

• to promote the rights of patients;
• to promote shared decision making between patients (or their surrogates if decisionally incapacitated) and their clinicians;
• to promote fair policies and procedures that maximize the likelihood of achieving good, patient-centered outcomes; and
• to enhance the ethical tenor of health care professionals and health care institutions.

Ethics committees or select members often help resolve ethical conflicts and answer ethical questions through the provision of consultations.

Who becomes a member of an ethics committee?

Ethics committee members usually represent major clinical services and other stakeholders in health care delivery. Thus, it is not uncommon for committee members to include clinicians (physicians and nurses) from medicine, surgery, and psychiatry, a social worker, a chaplain, and a community representative. Oftentimes, these committees also have a quality improvement manager, an individual responsible for the education program at the facility, a lawyer, and at least one individual with advanced training in ethics. This latter representative can come from a number of disciplines, including philosophy, law, medicine, theology, and anthropology. All members of the ethics committee take responsibility for learning techniques of ethical analysis (see Bioethics Tools) and the arguments surrounding most of the ethically charged issues in clinical practice.

Some ethics committees allow guests. These can include health sciences students, philosophy graduate students, physician trainees, facilitators, and patient representatives. Guests need to maintain the confidentiality of the information discussed at the meetings, often signing oaths to that effect.

What is the difference between an ethics committee and an ethics consultant?

In general, the strengths of having an ethics consultant is that she is a recognized expert, and the logistics of having someone perform a consultation is straight forward. The weaknesses are that clinicians can rely on this outside person for the answers to their questions and not develop their own expertise, and only one voice/perspective gets expressed. The major strength of having subcommittees (sometimes having 2-3 individuals per month) perform consultations is that this structure incorporates a diversity of views when considering a response to a consultative request. The major weakness is the difficulty in organizing having more than one person respond to a consult. Regardless of the ethics consultant versus subcommittee structure, it is advisable to review consults at the next available ethics committee meeting.

Under what circumstances should I use an ethics committee?

You should consider asking for a consult when two conditions are met:

1. you perceive that there is an ethical problem in the care of patients, and
2. resolution does not occur after bringing this to the attention of the attending physician.

At most hospitals, anyone may request an ethics consultation including the patient or family. Please check the hospital's policies to learn how to request an ethics consultation.

What will the ethics consultant do if I page her or him?

The consultant usually will ask you to specify the nature of the perceived ethical problem. He will meet with you and the other people involved in the situation. He will review the medical records. Oftentimes, the consultant will arrange an interdisciplinary meeting to review the specifics of the case and to facilitate communication across disciplines or between clinicians and the patient (and/or the family). The consultant will write a note and attempt to answer the proposed question(s). In the Seattle area, the recommendations will be anchored to the 4 box analysis of relevant case information, utilization of principles of clinical ethics, rigorous analysis of similar and dissimilar cases, and supporting arguments or data from the literature. If definitive recommendations cannot be made because there is disagreement among the ethics consult team, a clear explication of the arguments will be presented in the consultant's note.

How do I contact the ethics committee or request an ethics consultation?

Check with your hospital to identify the pager number to reach the ethics consultant. There should be an individual at each hospital who carries a pager for responding to ethics consultations. If this information is not readily available, call the UW Department of Medical History and Ethics for help locating a consultant (543-5145).