Functions and Outcomes of a Clinical Medical Ethics Committee: A Review of 100 Consults
Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined.
KeywordsEthics Hospital ethics committee End-of-life decision making Palliative care Consult service
- Gonsoulin, T. P., & Taube, J. M. (2002). Hospital ethics committees: Formation, function, and case consultation. Journal of the Louisiana State Medical Society, 154, 323–327.Google Scholar
- Romano, M. E., Wahlander, S. B., Lang, B. H., Li, G., & Prager, K. M. (2009). Mandatory ethics consultation policy. Mayo Clinic Proceedings, 84, 581–585.Google Scholar
- Schneider, P. A. D. (2000). A study of twelve hospital ethics committees in Eastern South Carolina. Journal of the South Carolina Medical Association, 96, 409–415.Google Scholar
- Sexson, W. R., & Thigmen, J. (1996). Organization and function of a hospital ethics committee. Clinics in Perinatology, 23, 429–436.Google Scholar