HOSPITAL ETHICS HOSPITAL ETHICS COMMITTEESCOMMITTEES

Bioethics

HSM 511

Kentucky School of Public Health

Mission

Hospital Ethics Committee

To create a mechanism to allow the patient or the patient’s designated representative to participate in the

consideration of ethical issues that arise in the care of the patient; to provide an organization and mechanism

for the consideration of ethical issues arising in the care of patients; and to provide education to care givers and

patients on ethical issues in health care.

University of Kentucky Hospital

Bioethics Issues:Past and Present

• Defining Death

• Foregoing/Withdrawing Treatment

• Permanently Unconscious Patients

• Withholding Food and Fluids

• In Vitro Fertilization

• Surrogate Parenting

• Fetal Tissue Research

• Euthanasia, Active and Passive

• Abortion

• Genetic Engineering

• Assisted Suicide

• Organ Transplantation

• Do Not Resuscitate Orders

• Informed Consent

• Access to Care/Indigent Care

• Allocation of Scarce Resources

• Cloning

University of Kentucky Hospital

Brief History of the Bioethics Movement

• 1962 Kidney Dialysis --”Patient Selection Committees”

• 1968 Definition of Irreversible Come (Brain Death) by ad hoc Committee of Harvard Medical School

• 1976 Karen Ann Quinlan --Prognosis Committees”

• 1980-83 President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research

• Early 80’s Ethics Committees Emerging:

1981 Less than 1% of Hospitals

1985 50% of Hospitals

Today 75% of Hospitals

• 1982 Baby Doe Care (esophageal atresia)

• 1989 Nancy Cruzan – right to die; removal of feeding tube

University of Kentucky Hospital

Joint Commission on Accreditation of Health Care Organizations

Standard: “Patient Rights and Organizational Ethics”

• Promote consideration of patient values and preferences including decision to continue treatment

• Recognize hospital’s responsibilities under the law

• Inform patients of their responsibilities in the care process.

• Manage the hospital’s relationships with patients and the public in an ethical manner.

University of Kentucky Hospital

UK Hospital Ethics CommitteeMembership

Profile: 7 Physicians 1 Dentist 6 Nurses 1 Social Worker 1 Philosopher 1 Clergywoman 2 Attorneys

1 Hospital Administrator20

University of Kentucky Hospital

Hospital Ethics Committee Membership

Joan Callahan, PhilosophyNirmala Desai, PediatricsAlan Howard, Family Nurse

LiaisonDayna Matthew, AttorneyDonna Farrar, Pastoral CareDavid Bartley, NursingRobert Benvenuti, UK

Compliance OfficerCarol Dickey, Nurse (Staff

Education)Vincent Mullen, Psychiatry

Johnnie Leonard, NursingDavid Nash, Dentistry, ChairMichael Rie, AnesthesiologyRandy Schleenbaker, Physical Medicine

and RehabilitationLin Dudik, Social WorkDavid Heistand, ResidentDaniel Beals, Pediatric SurgeryHeinrich Werner, PediatricsKaren Stefaniak, Chief Nursing Officer,

Hospital Administration

University of Kentucky Hospital

Responsibilities of Hospital Ethics Committee

• Education - facilitate educational opportunities for health care professionals, patients, and their families.

• Consultation - provide consultative services regarding ethical issues pertaining to a specific patient.

• Policies and Procedures - discussion and evaluation of policies and procedures having ethical implications.

University of Kentucky Hospital

Education

University of Kentucky Hospital

Principles of Patient Care

• Each patient shall be treated as a whole, irreplaceable, unique and worthy person.

• The patient’s safety, health, or welfare shall be protected and shall not be subordinated to organizational, staff, educational, or research interests or to any other end.

University of Kentucky Hospital

Principles of Patient Care (cont.)

• Behavior reflecting the dignity, responsibility and service orientation of health care professions worthy of the public’s respect and confidence, shall be practiced by all individuals.

• Each patient shall have a responsible attending physician or dentist.

University of Kentucky Hospital

Principles of Patient Care (cont.)

• The privacy of the patient and the confidentiality of every case and record shall be maintained.

• Patients and/or responsible family shall be informed at all stages of care about personnel responsible for the patient care, treatment plans, and activities for the patient, facilities and services available to the patient, and responsibilities of the patient and family.

University of Kentucky Hospital

Informed Consent

Respect for Autonomy

Beneficence

University of Kentucky Hospital

Advance Directives

Consultation

University of Kentucky Hospital

Policies and Procedures

University of Kentucky Hospital

Withholding/Withdrawing Potentially Life Sustaining

Treatment

-- Hospital Policy --

University of Kentucky Hospital

Levels of Support(Do not resuscitate orders)

Level 1Full support, including CPR

Level 2Full support, excluding CPR

(DNR)

Level 3Modified support, excluding

CPR (DNR)

May include: ventilation, entral feeding, dialysis, antibiotics, etc.

University of Kentucky Hospital

Guidelines on Pain Control for the Dying Patient

University of Kentucky Hospital

Resource Materials for aEstablishing A Hospital Ethics

Committee

University of Kentucky Hospital

Our Committee Can Present Programs On:

• Basic Principles of Bioethics• Withholding/Withdrawing Policies• Futile Treatment• Informed Consent• Managed Care Ethics• Consultation Competencies

and with adequate notice and time to prepare, other topics of interest in bioethics.