Developing Health Care Ethics Program

Reported by: MA. LEDI HAM B. LOOT

A healthcare ethics program can be instrumental in developing ethical competence and creating a climate conducive to ethical practice. Clinical practice, research and administration can reinforce ethical competence. Competence in ethics requires moral sensibility, moral responsiveness, moral reasoning and moral leadership. A sound health care ethics program should support the vision, mission, philosophy, strategic plans and policies related to human resource management and patient care. The Joint Commission on Accreditation of Health Care Organizations standards address ethical issues , specially focusing on respect for patients, responding to patient values and preferences, and patient responsibilities. Developing a healthcare ethics program gives support and foundation to an organizations ethics committee, which responds to the many challenging dilemmas facing healthcare providers. Hospital ethics committees began to appear in the 1970s and gained a high profile in 1982, when 2 Kaiser Permanente physicians were charged with first-degree murder. The physicians were adhering to a familys wishes to remove intravenous feeding tubes from a comatose, severely brain-damaged patient. At the time of the investigation, the judge found no guidelines within the organization to handle these issues. What is an Ethics Committee? Groups of persons who provide structure and guidelines for potential healthcare problems serve as an open forum for discussion, and function as patient advocates. It providesa mechanism for patients and caregivers to access and address ethical concerns. It is an educational and consultative committee whose role is to analyze ethical dilemmas and educate healthcare providers, patients and families regardinf difficult treatment decisions.(Venzon, 2010) Who belong to the Ethics Committee? The people who belong to the ethics committee vary from one institution to another, but almost all include a physician, a member of the administration, an RN, a clergy person, a philosopher with a background in ethics, a lawyer, and a person from the community. Members of the committee should not have any personal agenda that they are promoting and should be able to make decisions without prejudice on the basis of the situation and ethical principles. It is extremely important that nurses participate in these committees and that the ethical concerns of the nurses are recognized and address. (Catalano, 2006) ELEMENTS of an Ethics Program

1. Education- includes classes and information on topics such as natural law, deontology, utilitarianism, emotionalism, feminist, ethics etc. Developing a glossary of terms useful to understanding the vocabulary of an ethics committee is also important. Discussing clinical topics related to services offered in the facility helps to make the information disseminated applicable to the management of ethical dilemmas within the organization. Definition of terms applicable in the Ethics Committee Autonomy-refers to clients rights to to make decisions for himself, even if the healthcare provider does not agree with those decisions. Justice- is the obligation to be fair to all people (Catalano, 2006). Ethical principle that all equals should be treated equally and unequals should be treated according to their differences(Venzon, 2010) Beneficence- ethical principle which suggests that the actions one takes should be done in an effort to promote good. Non maleficence-principle that states that one should not do harm Veracity- principle of truthfulness. Fidelity- Faithfulness to ones duties being trustworthy and dedicated. Paternalism- principle apllies to a system under which an authority treats those under his control like a benevolent father would, such as regulating or supplying their needs.

2. Consultation- requires individuals skilled in assessment, process, and interpersonal competencies. Ethics consultation is often assigned to an individual or group with demonstrated competency and skill in ethics consultation. 3. Policy development- provides guidance to organizations in addressing ethical dilemmas. Tasks that must be assigned are: a. Reviewing existing policies from an ethical perspective b. Developing and writing policies on such topics such as informed consent, witholding / withdrawing treatment,advance directives, surrogacy, DNR, medical futility, privacy, confidentiality, organ transplant, donation, procurment, research,conflict of interest, impaired providers, use of reproductive and other technologies.

Jones found that offering ethics consultation reduces non-beneficial life sustaining treatments and that those patients receiving ethics consultation had fewer hospital ICU and ventilation days than those who received usual care. Responsibilities of the Ethics committee: Defuse fears within an institution

Educate caregivers on how ethics committees can be used for personal and professional benefit Be knowledgeable and non-threatening Serve in an advisory role to aid and assist decision makers Make available diverse values, knowledgeable and experience Not usurp authority from a primary physician

Ethics quality indicators are particularly important to end-of-life care and caring for individuals who are seriously ill. Guidelines and other type of protocols provide useful information in managing a clinical practice.

Source: Nursing Management Towards Quality Care, Lydia M. Venzon, Jennifer M.V. Nagtalon4th edQuezon City, 2010 Nursing Now!Todays Issues, Tomorrows Trends, Joseph T. Catalano4th editionPhiladelphia, 2006