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Ethics Committees: Group Process Concerns and the Need for Research

Published online by Cambridge University Press:  29 July 2009

Gregory J. Hayes
Gregory J. Hayes
Affiliation:
Assistant Professor and Chairman of the Department of Health Sciences, University of Nevada, Reno, and Assistant Clinical Professor of Family and Community Medicine at the University of Nevada School of Medicine
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Extract

Few ethics committees were in place when the New Jersey Supreme Court announced its ruling on the Quinlan case in 1976. Today, the vast majority of hospitals have formed ethics committees and their use in nursing homes and other healthcare facilities is growing. Given the increasing commitment to the use of ethics committees and their increasing influence on healthcare decision making, the careful evaluation of committee performance should be a high priority. Yet to date ethics committees appear to have undergone relatively little scrutiny. While professional articles on ethics committees do appear and at least one journal (CQ) sets aside a regular section for the discussion of “Ethics Committees at Work” articles to date have primarily been limited to essays, philosophical inquiries, reports, case studies, and, occasionally, surveys. The use of more structured research methodologies has been lacking. As a result, it is not yet clear, for example, what characteristics describe the best functioning ethics committee. Indeed, what constitutes best functioning lacks careful definition as well. Committee impact on medical decision making and patient outcomes, while discussed, has not been systematically measured and analyzed.

Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 4 , Issue 1 , Winter 1995 , pp. 83 - 91
Copyright
Copyright © Cambridge University Press 1995

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References

1. Lo, B. Behind closed doors: promises and pitfalls of ethics committees. New England Journal of Medicine 1987;317(1):46–50.CrossRefGoogle ScholarPubMed

2. Annas, GJ. Ethics committees: from ethical comfort to ethical cover. Hastings Center Report 1991;21(3):18–21.CrossRefGoogle ScholarPubMed

3. Kahnemann, D, Slovic, P, Tversky, A, eds. Judgment Under Uncertainty: Heuristics and Biases. New York: Cambridge University Press, 1982.CrossRefGoogle Scholar

4. Janis, IL. Crucial Decisions. New York: Free Press, 1989.Google Scholar

5. Shaw, ME. An overview of small group behavior. In: Spence, JT, Carson, RC, Thibaut, J, eds. University Programs Modular Studies. Morristown, New Jersey: General Learning Press, 1974.Google Scholar

6. Gastil, J. Identifying obstacles to small group democracy. Small Group Research 1993;24:5–27.CrossRefGoogle Scholar

7. Anderson, LR. Leader interventions for distressed group members: overcoming leaders' self-serving attributional biases. Small Group Research 1992;23:503–23.CrossRefGoogle Scholar

8. Kroon, MBR, vanKreveld, D, Rabbie, JM. Group versus individual decision making: effects of accountability and gender on groupthink. Small Group Research 1992;23:427–58.CrossRefGoogle Scholar

9. Kirchmeyer, C. Multicultural task groups: an account of the low contribution level of minorities. Small Group Research 1993;24:127–48.CrossRefGoogle Scholar

10. Baker, PM, Eaton, GG. Seniority versus age as causes of dominance in social groups: macaques and men. Small Group Research 1992;23:322–43.CrossRefGoogle Scholar

11. Department of Health and Human Services. Protection of Human Subjects. Title 45 CFR Part 46.107(a).

12. Department of Health and Human Services. Protection of Human Subjects. Title 45 CFR Part 46.107(b).

13. See note 5. Shaw, . 1974.Google Scholar

14. See note 6. Gastil, . 1993.Google Scholar

15. Kazdin, AE. Artifact, bias, and complexity of assessment: the ABCs of reliability. Journal of Applied Behavior Analysis 1977;10:141–50.CrossRefGoogle ScholarPubMed

16. Janis, IL. Groupthink: Psychological Studies of Policy Decisions and Fiascoes. Boston: Houghton Mifflin, 1983.Google Scholar

17. Phillips, D. Through the looking glass: new voices ask to be heard in bioethics. Cambridge Quarterly of Healthcare Ethics 1992;1:169–77.CrossRefGoogle Scholar

18. Robinson, J, Shaver, P. Measures of Social Psychological Attitudes. Ann Arbor, Michigan: Institute for Social Research, 1973.Google Scholar

19. See note 16. Janis, . 1983.Google Scholar

20. Anonymous. Western Bioethics News 1993;May:4.Google Scholar

21. Ketefian, S, Ormond, I. Moral Reasoning and Ethical Practice in Nursing: An Integrative Review. New York: National League of Nursing, 1988:28–9.Google Scholar

22. Reichardt, TD, Cook, CS. Beyond qualitative versus quantitative methods. In: Cook, TD, Reichardt, CS, eds. Qualitative and Quantitative Methods of Evaluation Research. Beverly Hills: Sage Publications, 1979.Google Scholar

23. Polit, DF, Hungler, BP. Nursing Research: Principles and Methods. 3rd ed.Philadelphia: Lippincott, 1987:349.Google Scholar

24. Knaus, WA, Wagner, DP, Draper, EA et al. , The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619–36.CrossRefGoogle ScholarPubMed

25. Knaus, WA, Wagner, DP, Lynn, J. Short-term mortality predictions for critically ill hospitalized adults: science and ethics. Science 1991;254:389–94.CrossRefGoogle Scholar

26. Knaus, W. Ethical implications of risk stratification in the acute care setting. Cambridge Quarterly of Healthcare Ethics 1993;2:193–6.CrossRefGoogle ScholarPubMed

27. Pozen, MW, D'Agostino, RB, Selker, HP et al. , A predictive instrument to improve coronary-care unit admission practices in acute ischemic heart disease: a prospective multicenter clinical trial. New England Journal of Medicine 1984;310:1273–8.CrossRefGoogle ScholarPubMed

28. Goldman, L, Cook, EF, Brand, DA et al. , A computer protocol to predict myocardial infarction in emergency department patients with chest pain. New England Journal of Medicine 1988;318:797–803.CrossRefGoogle ScholarPubMed

29. Silverstein, MD. Prediction instruments and clinical judgment in critical care. Journal of the American Medical Association 1988;260:1758–9.CrossRefGoogle ScholarPubMed

30. Poses, RM, Bekes, C, Winkler, RL et al. , Are two (inexperienced) heads better than one (experienced) head? Averaging house officers' prognostic judgments for critically ill patients. Archives of Internal Medicine 1990;150:1874–8.CrossRefGoogle ScholarPubMed

31. Castella, X, Gilabert, J, Torner, F et al. , Mortality prediction models in intensive care: acute physiology and chronic health evaluation II and mortality prediction model compared. Critical Care Medicine 1991;19:191–7.CrossRefGoogle ScholarPubMed

32. Portier, F, Defouilloy, C, Muir, JF et al. , Determinants of immediate survival among chronic respiratory insufficiency patients admitted to an intensive care unit for acute respiratory failure: a prospective multicenter study. Chest 1992;101:204–10.CrossRefGoogle Scholar

33. Balakrishnan, G, Aitchison, T, Hallworth, D et al. , Prospective evaluation of the paediatric risk of mortality (PRISM) score. Archives of Disease in Childhood 1992;67:196–200.CrossRefGoogle ScholarPubMed

34. Ayanian, JZ, Epstein, AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. New England Journal of Medicine 1991;325:221–5.CrossRefGoogle ScholarPubMed

35. Kjellstrand, CM. Age, sex, and race inequality in renal transplantation. Archives of Internal Medicine 1988;148:1305–9.CrossRefGoogle ScholarPubMed

36. Wenneker, MB, Weissman, JS, Epstein, A. The association of payer with utilization of cardiac procedures in Massachusetts. Journal of the American Medical Association 1990;264:1255–60.CrossRefGoogle ScholarPubMed

37. Hemenway, D, Killen, A, Cashman, SB et al. , Physicians' responses to financial incentives: evidence from a for-profit ambulatory care center. New England Journal of Medicine 1990;322:1059–63.CrossRefGoogle ScholarPubMed

38. Arkes, HR, Wortmann, RL, Saville, PD et al. , Hindsight bias among physicians weighing the likelihood of diagnoses. Journal of Applied Psychology 1981;66:252–4.CrossRefGoogle ScholarPubMed

39. Caplan, RA, Posner, KL, Cheney, FW. Effect of outcome on physician judgments of appropriateness of care. Journal of the American Medical Association 1991;265:1957–60.CrossRefGoogle ScholarPubMed

40. Sasse, K. Prognostic scoring systems: facing difficult decisions with objective data. Cambridge Quarterly of Healthcare Ethics 1993;2:185–91.CrossRefGoogle ScholarPubMed

41. Dawes, RM, Faust, D, Meehl, PE. Clinical versus actuarial judgment. Science 1989;243:1668–74.CrossRefGoogle ScholarPubMed

42. Kohlberg, L, Levine, C, Hewer, A. Moral Stages: A Current Formulation and a Response to Critics. New York: Karger, 1983.Google Scholar

43. Rest, JR. Development in Judging Moral Issues. Minneapolis: University of Minnesota Press, 1979.Google Scholar

44. See note 22. Reichardt, , Cook. 1979:9.Google Scholar

45. See note 22. Reichardt, , Cook. 1979:22–3.Google Scholar

46. Knaus, WA, Wagner, DP, Lynn, J. Short-term mortality predictions for critically ill hospitalized adults: science and ethics. Science 1991;254:389–94.CrossRefGoogle Scholar

47. See note 22. Reichardt, , Cook. 1979:23.Google Scholar

48. Ragin, CC. The Comparative Method: Moving Beyond Qualitative and Quantitative Strategies. Berkeley: University of California Press, 1987:viii.Google Scholar