Problem: EXPANDING ROLE OF THE ETHICS COMMITTEE

Typically, hospital ethics committees concern themselves with biomedical issues as they relate to end-of-life issues; unfortunately, they often fail to address external decisions that affect internal operations. The role of an organization's ethics committee is evolving into more than a group of individuals who periodically gather together to meet regulatory requirements and review and address advance directives and end-of-life issues. The organizational ethics committee has an ever-expanding role. This expanded role involves addressing external issues that affect internal operations (e.g., managed care, malpractice insurance, and complicated Health Insurance Portability and Accountability Act regulations that increase legal and other financial costs, thus burdening hospitals and slowing the progress of medicine). Ethics committees need to review their functions periodically and redefine themselves. The ethics committee is health care's sleeping giant. Because of its potential to bring about change, its mission must not be limited to end-of-life issues. Its vision must not be restricted to issues internal to the organization but must include external matters that affect internal operations. Failure to increase the good of others when one is knowingly in a position to do so is morally wrong. Preventative medicine and active public health interventions exemplify this conviction. After methods of treating yellow fever and smallpox were discovered, for example, it was universally agreed that positive steps ought to be taken to establish programs to protect public health. The wide variety of ethical issues that an ethics committee can be involved in is somewhat formidable. Although an ethics committee cannot address every issue that one could conceivably imagine, the ethics committee should periodically reevaluate its scope of activities and effectiveness in addressing ethical issues. Some of the internal and external issues facing an organization's ethics committee are presented later here.

Internal Ethical Issues

1. Dilemma of blind trials: Who gets the placebo when the investigational drug looks very promising?

2. Informed consent: Are patients adequately informed as to risks, benefits, and alternative procedures that may be equally effective, knowing that one procedure may be more risky or damaging than another (e.g., lumpectomy versus a radical mastectomy)?

3. What is the physician's responsibility for informing the patient of his or her education, training, qualifications, and skill in treating a medical condition or performing an 1invasive procedure?

4. What is the role of the ethics committee when the medical staff is reluctant or fails to take timely action, knowing that one of its members practices questionable medicine?

5. Should a hospital's medical staff practice evidence-based medicine or follow its own best judgment? 6. To what extent should the organization participate in and/or support genetic research?

7. How should the ethics committee address confidentiality issues?

8. To what extent should medical information be shared with the patient's family?

9. To what extent should the organization's leadership control the scope of issues that the ethics committee addresses?

10. What are the demarcation lines as to what information should or should not be provided to the patient when mistakes are made relative to his or her care?

External Ethical Issues

1. Does the ethics committee have a role in addressing questionable reimbursement schemes?

2. Should an ethics committee have its own letterhead? What value would this serve?

3. What role, if any, should an ethics committee play in the following scenario?