Ethics consultation

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 contemporary 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 QQuinlan (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 have ethics committees (McGee, Caplan, Sanogle, et al.). Around the same time, an Agency for Healthcare Research and Quality (AHRQ) study of ethics consultation in U.S. hospitals, a standard function of ethics committees today, found ethics consultation services in all U.S. hospitals with 400 beds or more, all federal hospitals, and all hospitals that are members of the Council of Teaching Hospitals (Fox). 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.

Contemporary ethics committees are usually standing committees with multidisciplinary representation, including medicine, nursing, social work, law, pastoral care, healthcare administration, and various specialty areas (McGee, et al.). The primary functions of contemporary ethics committees are ethics education, policy formation and review, and ethics consultation, in decreasing order of time commitment (McGee, et al.).

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