Why We Need Bioethics Committees?

Transcription

1 Objectives: Why? What? Who? How? Why We Need Bioethics Committees? Strategies for starting and sustaining a committee and some best practices - Felicia Cohn, PhD, Bioethics Director Kaiser Permanente Orange County, ASBH President - Tony Morton, MD, Co-Chair Mid-Atlantic Bioethics Committee 1. Describe a bioethics committee: Why? 2. Understand the key functions of a bioethics committee, and determine those most important to your institution: What? 3. Determine the best composition of members for your committee: Who? 4. Identify the organizational resources needed to support your committee: How? What is a Bioethics Committee? a group of individuals delegated to address ethical/moral issues that arise in the context of patient care. Why have a Bioethics Committee? Goals: To fulfill legal/regulatory requirements (Joint Commission: requirement for a mechanism for the resolution of ethical disputes). To promote the rights of patients; To promote shared decision making between patients (or their surrogates) and their clinicians; To address conflicts regarding patient care. To promote fair policies and procedures that maximize the likelihood of achieving good, patient-centered outcomes; and To enhance the ethical environment for health care professionals in health care institutions. Examples Why does your institution need a Bioethics Committee? What is your why? List your goals. Outline a mission statement. What s in a name? Bioethics Committee, Ethics Committee, Clinical Ethics Committee? The Kaiser Orange County Bioethics Committee is committed to advocating for the patient's "good" or best interest (beneficence), the patient's right to make decisions (autonomy or self-determination), the integrity of the health care professionals, and equitable access to appropriate and humane health care (justice and equity) provided in a professional manner that maintains patient/family dignity, privacy and respect for all patients. The mission of the Mid-Atlantic States Regional Bioethics Committee is to promote ethical reflection and action in the provision of health care. Goals of the committee include: Identification, analysis and resolution of ethical issues that arise in the delivery of high quality, affordable health care, Consultation relating to ethical concerns in policy development, and Provision of high quality education programs on bioethics. 1

2 What does a Bioethics Committee do? Traditional functions of a Bioethics Committee: Education Committee members Health Care Professionals Community Policy review and development Ethics Consultation What does a Bioethics Committee do? Traditional functions of a Bioethics Committee: Education Committee members Health Care Professionals = Preventative Community Policy review and development Ethics Consultation = Reactive, Proactive Organizational Ethics/Integrated Ethics Example Orange County: What is needed/expected of your ethics committee? Describe your what. List activities for a Statement of Purpose. Activities and responsibilities of the Hospital Bioethics Committee may include but are not limited to: Developing standards, policies and procedures in concert with the Regional Ethics Committee. Education of the committee itself, the hospital staff, physicians, community, and Kaiser Health Plan members regarding medical ethical issues. Providing forums for discussion among hospital and medical professionals (e.g. physicians, nurses, administrators, clergy, and ethicists) and other concerned parties about ethical matters. Providing case review and consultative or advisory assistance to patients, their families, and health care professionals in making decisions in the patient's best interest when confronted with questions or conflicts regarding values or ethical dilemmas. Example Mid-Atlantic Region: Consultation/Case Review The Regional Bioethics Committee is available to hear case discussions with the intent of clarifying the values that may be in conflict in making difficult medical decisions. Any Kaiser Permanente member or staff may request a review by the committee by contacting the chairperson or any committee member. Communication/Education The bioethics program includes ongoing efforts to make members and staff aware of their rights and responsibilities. In addition to educating the regional bioethics committee, the bioethics program is responsible for assisting staff with integrating ethical reflection in areas of decision making that routinely deal with issues that raise ethical concerns such as genetic diagnostics and therapeutics, new reproductive technologies, and end-of-life care. Information is made available to Kaiser Permanente clinicians and staff to address issues such as informed consent, end-of-life decision making, and confidentiality. Conferences and courses are offered to staff members when more detailed information in ethical questions is needed. Ethical Guidance The Bioethics committee, through meetings and special task force activities, provides broad guidelines to help Kaiser Permanente meet its ethical obligations as a health plan and medical care provider. The areas of concern include improving the health of the public, allocating limited resources wisely, exchanging information in a confidential manner, and providing an ethical environment in which all individuals are treated with fairness and respect. Representation from major clinical services and other stakeholders in health care delivery. physicians and nurses from medicine, surgery, and psychiatry, social workers, chaplains, other staff, eg. respiratory therapist quality improvement health educators legal Community members At least one member with advanced training in ethics *Guests, e.g. health sciences students, philosophy graduate students, physician trainees, facilitators, and patient representatives. *Guests must maintain the confidentiality of the information discussed at the meetings, sign a confidentiality statement. 2

3 Many Disciplines, Many Methods, One Field The Ideal Ethics Team? Achieving consensus or dis sensus? Medicine Philosophy Sociology Social work Chaplain/ Clergy Legal Philosophers Doctors Nurses History Methods Humanities Chaplains = strong background in their own discipline but think out of the box Lawyers Field of Bioethics Social workers From Methods in Medical Ethics Edited by Jeremy Sugarman, M.D., Daniel P. Sulmasy, O.F.M., M.D Membership - special issues: Administrator institutional bias? organizational moral distress? Clergy/Chaplain which denomination? already invested in patient? (conflict of duty) Legal rigidity, chill discussion? Community representative non-paid (incentive?), employer group repercussions? New members: Training Confidentiality statement signed On accepting new members - chair vs. committee decide? or both? role of leadership? Seeking Diversity? Sources of cases? Medical group vs. Health plan? Egalitarian - Cogency of reasoning > Position - Respectful but not deferential Terms permanent vs. rotating -length - re-appointment Who should serve on your committee? Describe your who : those currently serving on an existing committee, those who would serve on a new committee Consider the ideal composition: given your institutional needs, who else should serve? 3

4 Example: KP OC: Membership of this committee shall include representatives from the Medical Staff, Administration, Nursing and Ancillary Support Staff. There shall be at least one member who serves as a representative of the community. The Hospital Administrator, Chief of Staff, and Corporate Legal Counsel shall serve as ex officio members. The Co-chairs or their designees of this committee shall also serve on the Regional Bioethics Committee for Southern California. KP MAPMG: The Ethics Committee is sponsored by the MAPMG Quality Health Management Department and provides quarterly updates to the Regional Quality Improvement Committee. The Ethics Committee consists of no more than 20 and no less than 15 members reflecting specialty, gender, and ethnic diversity. There are standard departments and roles represented, including representatives from the following departments: Adult Medicine, Pediatrics, Surgical Specialties, Medical Specialties, OB- GYN, Nursing, Patient Safety-Risk Management, Membership Services, Operations Management, Pharmacy, Public Affairs/Marketplace, and a Community Liaison. Two members of the committee are selected to co-chair the committee by the Associate Medical Director of Quality. One co-chair will be a physician. The members serve voluntarily and are appointed by the Co-Chairs of the Committee based on interest and expertise in Bioethics. How will the Committee grow/ be maintained? Create expectations and meet needs Provide a timely consultations and useful advice Utilize committee members as Ambassadors Offer needed education Take responsibility for policies with ethical content Assess cases for systemic issues Quality measures Demonstrating Value How will the Committee grow/ be maintained? Resources needed Time for consultations and meetings, Frequency, During or after hours (union issues?) Meeting space Administrative support (minutes, track policies, log consults, coordinate educational offerings) Education and training, conference participation Communication/relationship with leadership How will your committee be established/ maintained? Describe your how. Group discussion How will you encourage acknowledgment of the need, establish expectations, and/or meet recognized needs? What resources do you need to establish/grow/or maintain a committee? Looking forward Next Steps and Best Practices 4

5 Goals: Integrative (Infiltrative?) Goals: Integrative (Infiltrative?) Integrative? Vs. Silo? 1. Hospital and Outpatient Committees wear ethics hat? 2. ICU Rounds - preventive ethics 3. Schwartz Rounds 4. Education Case-based mail outs e.g. Ethics Matters, noon Webex, inservices, conferences Conclusions: Where we have been Questions? 5