Hospital Ethics Committee
Hospital Ethics Committee
Can Help You!
Medical Care has Changed
Medical care has undergone remarkable changes in the last two decades. Machines peer into the workings of our bodies and monitor the functioning of our vital organs. Other machines even replace the functions of vital organs. Treatments and machines provide life-saving and life-sustaining possibilities which we have come to expect from a modern hospital. Although most of these new developments are beneficial, their use requires special communication among patient, families, and health care workers. The communication, ideally, takes into consideration the fact that people come to the hospital with different philosophies, beliefs, and expectations regarding their health care and their role in making decisions in that care. We have been asked by patients and families to explain their role in making these choices. The fact is, there are critical choices about your care that only you and your family can make. Making these decisions can be stressful. Often patients and their families are unfamiliar with medial events or the technology used in treatment. The physician will assist patients and their families to understand these medical advances and the new technology by explaining the medical aspects of care as well as the risks and benefits of providing or withholding treatment.
An ethical dilemma arises when there is conflict between loyalties, rights, duties or values, all of which are good in themselves, but not all of which can be satisfied in a particular situation. Sometimes the value of preserving life conflicts with other values (e.g., respecting patient wishes, relieving suffering, assuring equal access to health care).
Life Support Systems
People tend to think of these as ‘machines that keep you alive’, such as a ventilator that breathes for you when you can’t breath on your own. In the broad sense, however, a life support system can be something as simple as an I.V. that delivers nourishment to you. Many of us have heard about “people being kept alive on machines” and have decided that we want no part of that. The fact is, however, that “life support systems” are used many times every single day to help people over an illness and to return them to good health. Ventilators, for example, are frequently used after surgery to support patients’ breathing until they wake up enough to breathe on their own. Unfortunately, there are situations that occur in the course of serious illness that may require you, or your family, to make a decision about “sustaining life.” Although life itself is sacred and has very great value to most of us, there may come a time when the burdens of treatment (i.e., pain, suffering, emotional cost, etc., to patient and family) outweigh the potential benefits. In these situations, continuation of treatment may merely extend the process of dying and interfere with the expression of religious and spiritual values held by the patient. When it is clear to everyone that there is no chance for survival, despite all that is being done, many people would prefer not to be placed on, ore kept on, life sustaining systems. Others might want everything done, no matter what. Either choice is acceptable and ethical, and most religions recognize the right of the patient and family to make these choices. Deciding to forego life sustaining measures in no way means that all medical care stops. In fact, good supportive medical care, with patient comfort as the primary concern may become even more intensive at this time. Decisions such as these require much time and asking many questions. Few people make good decisions when they feel pressured and rushed, so it’s helpful to think about these possible dilemmas before they occur.
A code is potentially a life-saving set of procedures carried out on a person whose heart and/or lungs have suddenly stopped functioning. It is a resuscitation measure that includes external compression over the breast bone to stimulate the heart, electric shock to the heart, placing a tube in the windpipe and breathing for the person, using drugs to restore the blood pressure, etc. This type of resuscitation is clearly using life support systems nan all-out effort to SAVE a life. There are situations, of course, where this is not appropriate. For example, at the end of a terminal illness, the patient or family members may not want these “heroics” done since there is clearly no benefit to the patient. Your physician may bring up the question as to whether or not “code” should be performed, or you may feel free to ask about this at any time. It is important that any such decision on your part be discussed with your family and close friends whenever this is possible. You might wish to put your decision in writing concerning when you would choose a “code”. This is similar to the “Living Will” used in some states. You may wish to appoint someone who knows your wishes to make the decision for you should the time come that you cannot make it for yourself.”
Informed consent means that you have been given the information, have thought about it and agree to a procedure and/or treatment that is planned for you. Some questions you might ask include:
1. Why is this necessary now?
2. Are there any other reasonable alternatives?
3. What should I expect to be the outcome?
4. What are the risks involved?
You can’t give a meaningful consent unless you are truly “informed” and understand. This means asking questions.
The Ethics Committee serves as an educational forum for medical ethics within the hospital and community. It assists administration by reviewing and making recommendations for hospital policies. It is available on short notice to do case reviews of medical ethics dilemmas with anyone in the hospital: staff, patients, or families. It is advisory in nature and may make recommendations but not binding decisions.
Appointment and Purpose
The Ethics Committee is appointed by (insert hospital’s name) for the purpose of informing the Board, Administration, Medical and Hospital Staff about the development of bioethical issues. Since 19—, this committee has worked with the Hospital Staff, Physicians, and Administration in the appraisal of bioethical issues, providing a resource for problem solving and development of policy related to bioethical concerns.
It is understood that the committee is a consultative body rather than a decision-making body. In carrying out this commission the committee intends to:
A. Provide opportunity for consultation in the area of bioethical issues to physicians, hospital staff, patients and family upon request.
B. Initiate or support programs which raise consciousness of bioethical issues within the hospital and in the larger community it serves.
C. Promote inquiry into bioethical issues.
D. Serve as a source of information and consultation to the Board and Hospital.
Who is on the Ethics Committee
The Ethics Committee at (insert hospital’s name) is made up of a cross-section of professionals with open attitudes and the capacity for critical thinking. The professional disciplines represented are:
Board of Directors
Home Health Services
Mission Effectiveness Committee
Social Work Services
Other disciplines are invited as needed for special case reviews.
The Consultation Team exists to help patients, loved ones, and clinical professionals in the decision-making process. Because of their experience and skills, the Consultation Team can serve as an additional resource to the primary decision-makers; patient, family, physician. The Consultation team is not a decision-making group. We provide a forum of respect where the ethical, medical, psychosocial, administrative, and legal issues are addressed along with treatment options and recommendations regarding patient care.
Who May Request a Consultation?
Anyone (medical staff, employees, patients, and/or families) who would like help in resolving an ethical dilemma may contact a member of the Consultation Team. It should be remembered that the Consultation Team is not meant to replace, but rather to assist, those directly involved. If problems and concerns remain after communication between and among patient family attending and consulting physician, nurses, social workers, chaplains, and others, the Team will be happy to offer assistance.
Procedure for Consultation.
(insert person’s name) will serve as a point of contact between the Committee and the Hospital or Medical Staff. The request for a forum may be brought to this contact person who will in turn present the request to other members of the committee. There shall be agreement by three or more members (at least one of whom shall be a physician) as to the appropriateness of the request for consultation. There shall be agreement with the chairperson as to:
A. the information needed to discuss the case;
B. the procedure to be followed;
C. persons to be included in the consultation (e.g., patient, family, guardian, other ex-officio consultants such as clergy, medical, legal, or hospital personnel).
A summary of the consultation shall be placed in the committee files.
How to Make Contact
You may initiate a contact by requesting a referral from the hospital staff (nurse, social worker, chaplain), or your physician by calling (insert telephone number).
BECAUSE OF THE SENSITIVE NATURE OF DELIBERATIONS CONFIDENTIALITY WILL BE RESPECTED
Principles of Action (Patient Rights and Duties)
Patients have a right to participate in decisions concerning their course of treatment. So that patients can exercise this right, they should be informed of the diagnosis, the prognosis, the proposed treatment, other therapeutic options, and the risks and benefits of each course of treatment. When a patient is unable to make the decisions regarding treatment, family members or other loved ones must do so. They make decisions in accordance with the patient’s interest and wishes as these can be known. While the primary goal of health care is to further the patient’s well-being by promoting and protecting life, dying is recognized as a natural part of life. The dying patient is kept comfortable and his/her dignity is maintained. All patients have the duty to seek and to accept reasonable means to preserve their lives; however, not all medical treatments or other courses of action must be used in all circumstances. (insert hospital’s name) has the right and responsibility to maintain life in accordance with those … principles it professes.
Most of us become a bit timid in strange situations, especially when we are sick and perhaps frightened. It is your right (and even your duty to yourself) to understand as much about your medical care as you can. This means asking questions! Your doctor should be the primary source of many answers since you will be making a lot of decisions together. Ask the doctor to explain what you don’t understand. The other members of the team caring for you are also a source of answers: nurses, social workers, therapists, chaplains, etc. They can all help in different ways to answer your questions.
Such decisions are difficult, but they can be made easier by thoughtful discussions. Hopefully, our brief look at these difficult decisions has helped you give some thought to problems you may not have considered before. Unfortunately, dilemmas such as these are a fact of life, and we cannot ignore them. We would hope that spending some time thinking about these sorts of problems, and discussing them with your doctor and others, will help you make a better decision.
We trust you will not think that we are insensitive or presumptuous. If you wish to discuss any of the questions or issues we have raised, as well as any others, please feel free to approach your doctor, nurse, chaplain, social worker, or whomever you choose. We want to be of assistance whenever and however possible.”