CONSULTANCIES ETHIC

To What Extend Is It Realistic To Expect Consultancies to Act Ethically

To What Extend Is It Realistic To Expect Consultancies To Act Ethically?

Introduction

According to the Joe O'Mahoney, the dominant mechanism for dealing with clinical ethics problems in healthcare at the beginning of the twenty-first century is the ethics committee. Present in various capacities since the 1960s, ethics committees in their present form emerged in the late 1970s and 1980s in response to the growing need for a formal means to address ethical issues in clinical settings (Fost and Cranford). Early ethics committees were typically staffed by physicians and convened on an ad hoc basis. Indeed, in the period immediately following In re Quinlan (1976), ethics committees functioned largely as prognosis committees for difficult end-of-life cases in acute care settings. A 1983 study indicated that only about 1 percent of all U.S. hospitals had ethics committees, a figure that is consistent with this very limited function (Youngner, Jackson, Coulton, et al.).

As awareness of the value-laden nature of clinical decision making grew, so did the role and number of ethics committees. Just four years later, a 1987 study suggested the presence of ethics committees in over 60 percent of U.S. hospitals (Fleetwood, Arnold, and Baron). In 1998-1999, the University of Pennsylvania Ethics Committee Research Group (ECRG) conducted the most comprehensive study of ethics committees to date and found that approximately 93 percent of U.S. hospitals has ethics committees (McGee, Caplan, Sanogle, et al.). Though there has been no systematic study of the presence of ethics committees outside of hospital settings, it should be noted that ethics committees are present in many other healthcare settings, such as long term care, hospice, and even home care.

Consultancies Ethically Act EducationAccording to the Joe O'Mahoney, ethics committees have used a variety of means to meet this need. Ethics committees at academic medical centers, for example, often have members who are bioethics faculty at their respective centers or departments who are able to offer (or arrange for) ethics education for the committee. A notable example of this is the Veterans Health Administration (VHA), which has established a National Center for Ethics in Health Care, in part to assist in meeting the educational needs of ethics committee members throughout the VHA network (Glover and Nelson). Other ethics committees avail themselves of sustained continuing ethics education offered through regional ethics networks such as the University of Pittsburgh's Consortium Ethics Program (Pinkus), the Midwest Ethics Committee Network of the Medical College of Wisconsin (Kuczewski), or the West Virginia Network of Ethics Committees (Moss).

Ethics of ConsultanciesEthics consultation, perhaps the best known and most discussed function of ethics committees, commands only about 20 percent of ethics committee effort, with the average number of consults ranging from twelve to twenty-three per year (McGee, et al.). Though variously defined, ethics consultation is "a service provided by an individual or a group to help patients, families, surrogates, healthcare providers, or other involved parties address uncertainty or conflict regarding value-laden issues that emerge in healthcare" (American Society for Bioethics ...