HCA’s Clinical Ethics Manual
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Reasons for Developing an Ethics Committee
History of Ethics Committees
Common Threads of Clinical Ethics Committees
Joint Commission Standards
Defining Goals and Functions
Membership Requirements and Selection
Character of the Committee
HIPAA and Confidentiality
Functions of Ethics Committees
Educating the Committee
Educating the Hospital Community
Educating the Lay Community
Writing Policies and Guidelines
Elements of Developing Policy
The Role of Case Reviewer
Who Brings Optional Case Reviews to the Committee?
Forms of Consultation/Case Consult
• Record Keeping
• Committee Evaluation
Problems and Pitfalls for Ethics Committees
• Lack of Clarity in Committee Purpose
• Predominance of the Case Review Function
• Insufficient Member Education
• Enthusiasm and Frustration
• Hierarchy and Domination
• Inadequate Resources
• Committee Overlap
• Evaluation Failures
• Committee Liability
• Clinical Ethics Resource Links
• General Bioethics Links
• Academic Centers & Program Links
• Law Links
• State/Regional Bioethics Networks
Clinical ethics committees in each hospital are an essential part of the HCA Ethics and Compliance Program. The following document provides a concise, functional guidebook for the operation of an effective hospital clinical ethics committee.
There are strong reasons for the establishment of clinical ethics committees: (1) An obligation to patients and the protection of patient rights; (2) An increasing number or guidelines from external quality agencies including the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (3) federal and state privacy regulations; and (4) A mark of professionalism.
The ethical dilemmas of modern health care are a result of many factors. Such factors include the focus on individual (patient) rights and choice, the development of new technology, the effect of global budgets and global rationing schemes, rising costs, scarcity of resources, the uncertain or conflicting social and religious values, and the changing relationships between payer, provider and patient. In today’s rapidly changing healthcare industry, ethical issues have come to represent both challenges and opportunities.
Not surprisingly, a subject of importance is how these and other ethical issues are addressed by healthcare organizations. From the bedside care of patients to the ethical and compliance considerations associated with the operational aspects of a healthcare entity, organizational ethics broadens the understanding of ethical considerations.
In this guidebook, Section 1 covers the reasons for establishing a clinical ethics committee, the history, common threads, and current JCAHO standards regarding clinical ethics. Section 2 is more extensive, covering committee structure, function and goals, membership, problems and pitfalls. In sections 1 & 2, selected guidelines were adapted with permission from the Handbook for Hospital Ethics Committees by Judith Wilson Ross with Sister Corrine Bayley, Vicki Michel and Deborah Pugh, published by American Hospital Publishing, 1986 and Health Care Ethics Committees by Judith Wilson Ross, M.A., John W. Glaser, S.T.D., Dorothy Rasinski-Gregory, J.D., M.D., Joan McIver Givson, Ph.D., Corrine Bayley, M.A., published by American Hospital Publishing, 1993. (All rights are reserved.) Section 3 lists various educational websites and resources for ethics committee members and facility staff.
Rosanne B. Prats, M.H.A., Senior Ethics Analyst, HCA...
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