The role of ethics committees

Ethics committees in medical settings serve the main objectives of guiding ethical decision-making in clinical cases, developing and revising hospital policies regarding ethical issues, and educating healthcare professionals on ethical aspects of patient care.

How do ethics committees influence medical decision-making?

Opinion 10.7 published by the American Medical Association states, “Ethics committees, or similar institutional mechanisms, offer assistance in addressing ethical issues that arise in patient care and facilitate sound decision making that respects participants’ values, concerns, and interests.” When faced with challenging cases, such as those involving a variety of medical cases, these committees bring together diverse perspectives, including medical, legal, ethical, and sometimes spiritual viewpoints. They offer a structured process for examining the ethical dimensions of a case, ensuring that decisions are not only medically sound but also ethically and legally defensible.

By considering the ethical principles of autonomy, beneficence, non-maleficence, and justice, they strive to balance the rights and needs of patients with the responsibilities and limitations of healthcare providers. Additionally, they navigate the healthcare legal framework, ensuring that decisions comply with existing laws and regulations. 

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Cases typically requiring the involvement of ethics committees

• End-of-life decisions: Issues like withdrawing or withholding life-sustaining treatment, do-not-resuscitate (DNR) orders, and palliative care options.
• Informed consent: Situations where patient competence or decision-making capacity is in question, especially in cases involving minors, mentally incapacitated individuals, or unconscious patients.
• Conflicts between patient autonomy and medical advice: Instances where patients' or families' wishes conflict with medical recommendations, such as refusal of treatment.
• Resource allocation: Decisions regarding the distribution of limited healthcare resources, like organ transplantation eligibility or access to experimental treatments.
• Confidentiality and privacy issues: Navigating situations involving sensitive patient information, particularly when disclosure could impact patient well-being or public health.
• Medical futility: Cases where treatments may no longer benefit the patient, leading to discussions about the appropriateness of continuing such interventions.
• Ethical issues in pediatrics: Unique concerns in pediatric care, including parental decision-making rights, child consent, and best interest determinations.
• Research ethics: Evaluating the ethical implications of medical research, especially involving human subjects, experimental treatments, or ethical dilemmas arising during clinical trials.
• Genetic testing and counseling: Issues related to genetic information, such as the implications of genetic testing, confidentiality of results, and informed decision-making.
• Cultural and religious considerations: Addressing situations where cultural or religious beliefs influence medical decisions, ensuring respectful and culturally competent care.

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How are ethics committees structured and who are their members?

A typical ethics committee boasts a diverse composition, drawing professionals from various backgrounds and areas of expertise to foster a multidisciplinary approach. Typically, these committees include medical practitioners such as doctors and nurses, who deeply understand clinical care and patient needs. They often feature legal experts, who provide insights into the legal aspects of healthcare decisions. 

Ethicists or bioethicists are also key members, offering specialized knowledge in ethical theories and principles. In many cases, social workers and chaplains are part of the team, contributing perspectives on patient care's social, emotional, and spiritual dimensions. Additionally, representatives from the patient community may be included to ensure that patient perspectives and experiences are considered. This approach enriches the committee’s functionality by combining diverse viewpoints and expertise, which leads to more balanced, well-rounded, and ethically sound decision-making.

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FAQs

Who do ethics committees interact with? 

Ethics committees interact with patients, families, healthcare providers, and hospital staff to address ethical issues and dilemmas in patient care.

How are members chosen?

Members of ethics committees are typically chosen based on their expertise, experience, and representation from various disciplines within the healthcare setting, often including doctors, nurses, social workers, legal advisors, and community representatives.

What is the difference between an ethics committee and a hospital board?

The difference between an ethics committee and a hospital board is that ethics committees focus on addressing ethical issues and dilemmas in patient care, while hospital boards are responsible for the overall governance and strategic direction of the hospital.