Objectives

1. Describe the goal of healthcare ethics committees’ (HECs) policy-making activities.

2. Understand how the HEC’s purview and mission within the organization shape its policy-making role.

3. Suggest tools and strategies supporting HECs’ development of efective ethics policies.

4. Identify internal challenges and external barriers to successful policy development.

Case 1

At its annual review of the hospital’s ethics consultation activities, HEC members noted a series involving elderly ICU patients who lacked both decision-making capacity and a legally authorized representative. The HEC convened a subcommittee to propose a new institutional policy addressing how to proceed with decision-making for these patients. The subcommittee crafted a policy that specified steps for staff to take under such circumstances. The HEC obtained the approval of the organization’s governing entity and implemented an education program to familiarize staff with the new policy on patients without surrogates. A year later, the HEC reviewed the policy’s effectiveness, and modified it to apply to outpatients presenting with similar characteristics.

Case 2

A pathologist who over saw the blood bank at a large, research-oriented hospital asked the HEC Chair to organize a policy initiative thatwould govern tissue-based research. The context for the request reflected the impending federal deadline for compliance with the Privacy Rule in the Health Insurance Portability and Accountability Act, as well as growing ethical consensus that tissue-based research required informed consent from patient sources.

A member of the HEC agreed to lead the effort, assisted by a task force of over 20 employees. The task force conducted needed research into existing practices; sought recommendations from literature and topic experts; drafted policy language; circulated proposed versions among numerous departments within the organization, including legal counsel; ushered the policy through review by organizational leadership; and eventually obtained approval by themedical staff and managing board. Upon their approval, the HEC’s responsibility officially terminated.