Education

In re QQuinlan gave impetus to the development of early ethics committees. Since, as mentioned above, these committees were largely staffed by physicians and primarily concerned with prognosis issues in end-of-life situations, the educational needs of ethics committee members were rather narrowly focused. Encouraged, among others, by a President's Commission (1983), professional societies such as the American Medical Association (1985), and accrediting bodies such as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO, 1992), ethics committees evolved to become the primary mechanism through which clinical ethics issues are formally addressed. Educational efforts of a thriving ethics committee should include self education, education of health professionals and staff, and community outreach. Of these, self education is critical as it is an important precondition of both sound policy formation and review and ethics consultation. Consistent with this, the 1999 ECRG study indicated "self education" as the single activity to which ethics committees devoted the highest percentage of time (McGee, et al.).

Though physicians and nurses make up the largest majority of ethics committee membership, most ethics committees are multidisciplinary with members from social work, pastoral care, legal, and administration, among others (McGee, et al.). This broad spectrum of health professionals brings valuable experience and perspective in dealing with clinical ethical issues, which are inevitably complex and multilayered. The vast majority of ethics committee members, however, have no formal education or training in clinical ethics; thus self education is an important ethics committee activity (Fox; McGee, et al.). Indeed, in the 1999 ECRG study mentioned above, half of all ethics committee chairs reported "feeling inadequately prepared to address" the issues they face (McGee, et al.). This is not surprising, given that ethics committees face an array of complex clinical ethics issues, including informed consent and refusal of treatment, decision capacity or competence, confidentiality and privacy, minors and decision making, and a host of issues related to end of life decision making. To deal with these and other clinical ethics issues, ethics committees need to have a sustained self-education program.

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. Some ethics committees that are part of large integrated systems may have access to system-supported centers or departments of clinical ethics that themselves offer ethics education for committee members. 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). Ethics committees without access to these types of resources might identify one or two members willing to do formal education and training in clinical ethics through the completion of a clinical bioethics degree, fellowship, or certificate program. 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). These efforts foster partnerships to bring the bioethics resources often present in primarily academic settings to serve the broader healthcare community (Glover and Nelson).

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