Are Ethics Committee Members Competent to Consult?

Shalit R. , “When We Were Philosopher Kings: The Rise of the Medical Ethicist,” The New Republic, 216, no. 17 (1997): 24–28; Bailey R. , AWarning: Bioethicists May be Hazardous to Your Health: The Moralists' Attack on Medical Progress and Patient Freedom,@ <http://reason.com/9908/fe.rb.warning.html> (August/September, 1999): 1–13.

Blake D. , Vital Signs 75, (September, 1998): 1–2.

“Experts in Ethics?: The Authority of the Clinical Ethicist,” Hastings Center Report, 28, no. 6 (1998).

The Task Force adopted an “ethics facilitation approach and rejected an “authoritarian” and “pure facilitation” approach. The ethics facilitation approach includes two core features: “identifying and analyzing the nature of the value uncertainty and facilitating the building of consensus.” See “Core Competencies for Health Care Ethics Consultation,” American Society for Bioethics and Humanities, (1998), herinafter “Core Competencies,” at 6.

The Task Force consisted of scholars from the Society for Health and Human Values and Society for Bioethics Consultation. These two groups subsequently merged and are now the American Society for Bioethics and Humanities.

See Core Competencies, supra note 4.

Id. at 12.

Id. at 13.

Id. at 14.

Id. at 16–21.

Ethical Currents, no. 52 (Winter, 1998).

The Task Force delineates basic ethics consultation skills and knowledge that each member of a consulting team needs to be deemed “competent.” In addition, the Task Force recommends that at least one member of the consult team have advanced knowledge in certain areas. The only advanced skill that we included, which was not required for all team members, was “the ability to educate involved parties regarding the ethical dimensions of the case.” See “Core Competencies,” supra note 4 at 15)

See MD. CODE ANN., HEALTH-GEN. II ° 19–371 to 374 (1996).

It was modeled, in part, after a survey conducted by Hoffmann in 1990 that gathered information on demographics and operations of ethics committees, but did not ask about education of committee members. See Hoffmann D.E. , “Does Legislating Hospital Ethics Committees Make a Difference? A Study of Hospital Ethics Committees in Maryland, The District of Columbia, and Virginia,” Law, Medicine & Health Care, 19, nos.1–2 (1991): 105–119. This instrument was used in order to compare changes in committee structure and operations of ethics committees in Maryland between 1990 and 1998.

Knowledge questions included general ethical concepts as well as content specific to Maryland healthcare policy.

See “Core Competencies,” supra note 4 at 14–15.

Fox E. Stocking C. , “Ethics Consultants' Recommendations for Life-Prolonging Treatment of Patients in a Persistent Vegetative Stage,” JAMA, 270 (1993): 2578–2582.

This demonstrates the problem of attempting to measure ethics knowledge quantitatively—since the only questions included were ones in which there was consensus among experts as to the answer, the result was a low variance in response scores, which contributed to the low reliability score.

Healthcare Infosource, Inc., a subsidiary of American Hospital Association, One North Franklin, Chicago, IL. Three of the 70 hospitals listed had either closed or had merged with another hospital making the total sample size 67.

The study was determined to be exempt from the University of Maryland's Institutional Review Board (IRB) process. (Memo to Diane Hoffmann from the University of Maryland, Baltimore IRB on June 8, 1998.)

Other types of members listed by one or two committees included risk managers, patient representatives, hospital security services, representatives from hospice, mental health, home health and the hospital board. This is relatively consistent with findings of a study of ethics committees in 1990 in Maryland, the District of Columbia, and Virginia. See Hoffman D.E. , supra note 15, at 108. However, this more recent study found that more committees included a representative of the hospital administration, more included a lawyer, and fewer included an ethicist, than was the case ten years ago.

Just over ten percent of committees (12.5%) had chairs who were social workers, nurses, or administrators. Two committees (5%) had chairs who were chaplains or members of the clergy.

Institutional response rate = percentage of individuals at each institution who were identified by chairs as able to perform ethics consults, and who responded. Thus, if in Phase I a chair identified 9 individuals as able to perform ethics consults and 3 returned the survey in Phase II, the institution would have a 33% response rate.

One individual did not answer this question, one reported performing 40 consults, and one reported performing 80 consults. To avoid inflation of the mean number of consults due to the outlier of 80 consults performed, that value was “windsorized' in statistical computations from 80 to 41.

Statistical significance levels should be interpreted conservatively, as assumptions for statistical tests were not always met (e.g., unequal group sizes were unavoidable, and severely skewed distributions were corrected through logarithmic transformation for running the Pearson correlations but not for the ANOVA tests). In addition, multiple testing increased the possibility of a fishing error. Results could be interpreted more cautiously by using a significance level of .025 instead of .05 to determine statistical significance.

Lawyers' responses were not analyzed separately as the group was too small (n=9) for a statistically robust comparison.

This includes two individuals with a Masters in bioethics, and the rest with a Masters or PhD in an ethics-related discipline (see text for how this was interpreted by respondents).

Negatively skewed distributions for “number of consults performed” and “perceived familiarity with ethics-related hospital policies” were normalized through logarithmic transformation.

See “Core Competencies,” supra note 4 at 30.

Bandura A. , “Self-Efficacy: Toward a Unifying Theory of Behavioral Change,” Psychology Review, 84 (1977): 191–215.

Parle M. Maguire P. Heaven C. , “The Development of a Training Model to Improve Health Professionals' Skills, Self-Efficacy and Outcome Expectancies When Communicating with Cancer Patients,” Social Science & Medicine, 44, no. 2 (1997): 231–240.

The SUPPORT Principal Investigators, “A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), JAMA, 274, no 20 (1995): 1591–1598. See also Baile W.F. , “Communication Skills Training in Oncology. Description and Preliminary Outcomes of Workshops on Breaking Bad News and Managing Patient Reactions to Illness,” Cancer, 86, no. 5, 887–897, and see Cantwell B.M. Ramirez A.J. , “Doctor-Patient Communication: A Study of Junior House Officers,” Academic Medicine, 74, no. 11, 1242–1248.

Northouse L.L. Northouse P.G. , Health Communication: Strategies for Health Professionals, 3rd ed. (Stamford, CT: Appleton & Lange, 1998).

For examples of such research, see Hope T. Fulford K.W. , “The Oxford Practice Skills Project: Teaching Ethics, Law and Communication Skills to Clinical Medical Students,” Journal of Medical Ethics, 20, no. 4 (1994): 229–34; and Parle M. Maguire P. Heaven C. , “The Development of a Training Model to Improve Health Professionals' Skills, Self-Efficacy and Outcome Expectancies When Communicating With Cancer Patients,” Social Science & Medicine, 44 (1997): 231–40.