Development of a hospital ethics committee: lessons from five years of case consultations.
The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care. Most patients evaluated have been unable to clearly express their wishes concerning further treatments, highlighting the need for promoting advance directives. When resorting to substituted judgment, our committee has supported continued care in a majority of cases. Limitation of the consultation process to the attending physician has, in our experience, actually served to increase the credibility of the committee and has promoted acceptance of its recommendations. The committee's most useful function seems to be in assisting physicians and their patients in defining realistic goals and limitations of treatment. Within this context, the coming decade may find ethics committees concerned less with promoting the autonomous wishes of individual patients than with defining the limits of that autonomy against the competing demands of the larger society. Such a shift should be approached with caution.
Andereck
W S
WS
Program of Medicine and Philosophy, Pacific Presbyterian Medical Center, San Francisco, CA.
D016223:Advance Directives; D002140:California; D017041:Ethics Committees / Q000458:organization & administration*; D028741:Ethics Committees, Clinical; D033061:Ethics Consultation; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D016743:Mental Competency; D017146:Models, Organizational; D009937:Organizational Objectives; D016134:Organizational Policy; D017063:Outcome Assessment, Health Care; D010344:Patient Advocacy; D010348:Patient Care Team / Q000458:organization & administration; D026684:Personal Autonomy; D016730:Program Development; D012017:Referral and Consultation / Q000458:organization & administration*; D040841:Resource Allocation; D028761:Withholding Treatment