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Chapter 14

Hospital Ethics Committees: Rules, Membership Structure and

Difficulties

Hospital Issues Affect HECs

• The hospital mission is challenged by the need to be profitable and patient centered.

• Technology growth and sophistication are also challenges.

• Hospitals can respond to their many challenges through ethics committees.

HECs Assist With…

• Case consulting. • Policy development. • Joint Commission mandates. • Patient issues. • Financial issues. • And many other areas.

HECs in the 21st Century

• Develop standards and policies. • Educate staff members. • Provide clinical consulting. • Assist with resource allocation decisions.

Developing Policies/Standards

• HECs review existing standards and new ones for compliance with the mission, and conflict of interest, etc.

• They may be involved in patient-related policies.

• They may also be involved in policies on management issues.

Education

• The HEC sets goals for ethics education. • HECs can also provide ethics education. • HEC members must also be educated in order

to make sound decision recommendations for the hospital.

Clinical Consultation

• Clinical consultation is the most common function for HECs.

• Consultations can be made by the whole HEC or by small groups within it.

• Retrospective reviews are also used for discussion and learning.

Resource Allocation

• Because of the increase in utilization and changes in reimbursement, HECs are part of resource allocation decisions.

• Macroallocation issues need to be analyzed. • Microallocation issues center on patients and

scarce resources. • Cost and cost containment will continue to

matter.

HEC Membership

• HECs should include • Medical staff members. • Nursing staff members. • Administration and social services. • Clergy or bioethicists. • Hospital board member. • Patient representative.

HEC Membership

• Uses an interdisciplinary approach. • Considers the patient’s needs and desires. • Considers the effect on the caregiver. • Uses an interdisciplinary approach to meet the

requirements of regulators.

Background and Education

• HEC members should be chosen carefully. They should have expertise in ethics and in the ability to solve problems.

• HECs need to choose a model for decision making and be trained on this model.

• Procedural justice is required.

Institutional Commitment

• HECs need support from top levels of administration.

• The Chair of the HEC needs to be respected and understand the clinical side of the hospital.

• Ideally, the HEC should report to senior management.

Structures: Three Models

• Each model has advantages and disadvantages.

• They include the ethics committee: • As a committee of the hospital board. • As a committee directly reporting to the CEO. • As a committee reporting to the hospital

medical staff committee.

Difficulties and Needs Include:

• Lack of funding and time to address significant ethics issues.

• Lack of justification for expenditures for ethics committees.

• Need for more education on emerging issues.

Difficulties and Needs Include:

• Lack of training on business, finance, and management ethics.

• Lack of information regarding the public’s position on health care issues.

• The need to identify who and what the are. • The need to overcome clinical staff barriers to

use of HECs.

Practitioner’s View Update

• HECs will have more challenged because of the passage of PPACA.

• The volume of Baby Boomers entering the healthcare system also promises new ethics issues.

• Economic credentially will continue to be an ethics challenge.

Practitioner’s View Update

• CMS is becoming an active payer of healthcare claims through the VBP system.

• Tying reimbursement to patient satisfaction scores may open up Pandora’s box of ethics issues.

• Patient and financial issues will challenge HECs now and in the future.

In Summary…