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Functions, Operations and Policy of a Volunteer Ethics Committee: A Quantitative and Qualitative Analysis of Ethics Consultations from 2013 to 2018

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Abstract

Few institutions have published reviews concerning the case consultation history of their ethics committees, and policies used by ethics committees to address inappropriate treatment are infrequently reviewed. We sought to characterize the operation of our institution’s ethics committee as a representative example of a volunteer ethics committee, and outline its use of a policy to address inappropriate treatment, the Conscientious Practice Policy (CPP). Patients were identified for retrospective review from the ethics consultation database. Patient demographics, medical admission information, and consultation information were obtained from the medical record. Consultation notes were analyzed with directed content analysis. The use of the CPP was documented in each case. Groups of interest were compared via two-sample t-tests. There were 178 consultations between 2013 and 2018. The majority originated from medicine services (N = 145, 82.4%). The most common consultation reasons were end-of-life balances of acute and palliative care (N = 85, 47.2%), best interest standard (N = 82, 46.1%), medical futility (N = 68, 38.2%), and code status and intubation status (N = 67, 37.6%). Average age was 65.5 years and average hospitalization before consultation was 51.4 days. 92 patients (53.3%) had a code status change that occurred after consultation. A policy to address inappropriate treatment (CPP) was used in 42 (23.9%) of the consultations. Bivariate analysis demonstrated a reduction in policy use over time, with use in 32.1% of consultations from 2013 to 2016 and 11.4% of consultations 2017–2018, p = 0.002. End-of-life issues were the most common reason for consultation. Our consultation volume was lower than previously-published reports. A policy used to address inappropriate treatment was frequently used, although use decreased over time.

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Not available outside of institutional ethics committee.

References

  • Au, S. S., Couillard, P., Roze Des Ordons, A., Fiest, K. M., Lorenzetti, D. L., & Jette, N. (2018). Outcomes of ethics consultations in adult ICUs: A systematic review and meta-analysis. Critical Care Medicine, 46(5), 799–808. https://doi.org/10.1097/CCM.0000000000002999.

    Article  Google Scholar 

  • Bruce, C. R., Smith, M. L., Hizlan, S., & Sharp, R. R. (2011). A systematic review of activities at a high-volume ethics consultation service. Journal of Clinical Ethics, 22(2), 151–164.

    Google Scholar 

  • Council on Ethical and Judician Affairs AMA. (1999). Medical futility in end-of-life care: Report of the Council on Ethical and Judicial Affairs. JAMA, 281(10), 937–941.

  • Courtwright, A. M., Brackett, S., Cadge, W., Krakauer, E. L., & Robinson, E. M. (2015). Experience with a hospital policy on not offering cardiopulmonary resuscitation when believed more harmful than beneficial. Journal of Critical Care, 30(1), 173–177. https://doi.org/10.1016/j.jcrc.2014.10.003.

    Article  Google Scholar 

  • Faith, K., & Chidwick, P. (2009). Role of clinical ethicists in making decisions about levels of care in the intensive care unit. Critical Care Nurse, 29(2), 77–84. https://doi.org/10.4037/ccn2009285.

    Article  Google Scholar 

  • Falkum, E., & Forde, R. (2001). Paternalism, patient autonomy, and moral deliberation in the physician-patient relationship. Attitudes among Norwegian physicians. Social Science & Medicine, 52(2), 239–248. https://doi.org/10.1016/s0277-9536(00)00224-0.

    Article  Google Scholar 

  • Fine, R. L., & Mayo, T. W. (2003). Resolution of futility by due process: Early experience with the Texas Advance Directives Act. Annals of Internal Medicine, 138(9), 743–746. https://doi.org/10.7326/0003-4819-138-9-200305060-00011.

    Article  Google Scholar 

  • Fox, E., Myers, S., & Pearlman, R. A. (2007a). Ethics consultation in United States hospitals: A national survey. American Journal of Bioethics, 7(2), 13–25. https://doi.org/10.1080/15265160601109085.

    Article  Google Scholar 

  • Fox, E., Myers, S., & Pearlman, R. A. (2007b). Ethics consultation in United States hospitals: A national survey. American Journal of Bioethics, 7(2), 13–25. https://doi.org/10.1080/15265160601109085.

    Article  Google Scholar 

  • Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687.

    Article  Google Scholar 

  • Joint Commission on Accreditation of Healthcare Organizations. Patient rights. (1993). Accreditation Manual for Hospitals, O. T. Chicago: Joint Commission on Accreditation of Healthcare Organizations, pp. 1–16.

  • Kodish, E., Fins, J. J., Braddock, C., 3rd, Cohn, F., Dubler, N. N., Danis, M., et al. (2013). Quality attestation for clinical ethics consultants: A two-step model from the American Society for Bioethics and Humanities. Hastings Center Report, 43(5), 26–36. https://doi.org/10.1002/hast.198.

    Article  Google Scholar 

  • Olmstead, J. A., & Dahnke, M. D. (2016). The need for an effective process to resolve conflicts over medical futility: A case study and analysis. Crit Care Nurse, 36(6), 13–23. https://doi.org/10.4037/ccn2016472.

    Article  Google Scholar 

  • Pope, T. M. (2016). Procedural due process and intramural hospital dispute resolution mechanisms: The Texas Advance Directives Act. Saint Louis University Journal of Health Law & Policy, 10, 93–158.

    Google Scholar 

  • Post, L. F., & Blustein, J. (2015). Handbook for health care ethics committees. Baltimore: Johns Hopkins University Press.

  • Robinson, E. M., Cadge, W., Zollfrank, A. A., Cremens, M. C., & Courtwright, A. M. (2017a). After the DNR: Surrogates who persist in requesting cardiopulmonary resuscitation. Hastings Center Report, 47(1), 10–19. https://doi.org/10.1002/hast.664.

    Article  Google Scholar 

  • Robinson, E. M., Cage, W., Erler, K., Brackett, S., Bandini, J., Cist, A., et al. (2017b). Structure, operation, and experience of clinical ethics consultation 2007–2013: A report from the Massachusetts General Hospital optimum care committee. Journal of Clinical Ethics, 28(2), 137–152.

    Google Scholar 

  • Rosoff, P. M. (2013). Institutional futility policies are inherently unfair. HEC Forum, 25(3), 191–209. https://doi.org/10.1007/s10730-012-9194-9.

    Article  Google Scholar 

  • Schneiderman, L. J., Gilmer, T., Teetzel, H. D., Dugan, D. O., Goodman-Crews, P., & Cohn, F. (2006). Dissatisfaction with ethics consultations: The Anna Karenina principle. Cambridge Quarterly of Healthcare Ethics, 15(1), 101–106. https://doi.org/10.1017/s0963180106060117.

    Article  Google Scholar 

  • Siegler, M. (2019). The ASBH approach to certify clinical ethics consultants is both premature and inadequate. Journal of Clinical Ethics, 30(2), 109–116.

    Google Scholar 

  • Swetz, K. M., Crowley, M. E., Hook, C. C., & Mueller, P. S. (2007). Report of 255 clinical ethics consultations and review of the literature. Mayo Clinic Proceedings, 82(6), 686–691. https://doi.org/10.4065/82.6.686.

    Article  Google Scholar 

  • Tapper, E. B., Vercler, C. J., Cruze, D., & Sexson, W. (2010). Ethics consultation at a large urban public teaching hospital. Mayo Clinic Proceedings, 85(5), 433–438. https://doi.org/10.4065/mcp.2009.0324.

    Article  Google Scholar 

  • Wasson, K., Anderson, E., Hagstrom, E., McCarthy, M., Parsi, K., & Kuczewski, M. (2016). What ethical issues really arise in practice at an academic medical center? A quantitative and qualitative analysis of clinical ethics consultations from 2008 to 2013. HEC Forum, 28(3), 217–228. https://doi.org/10.1007/s10730-015-9293-5.

    Article  Google Scholar 

  • White, D. B., & Pope, T. M. (2012). The courts, futility, and the ends of medicine. JAMA, 307(2), 151–152. https://doi.org/10.1001/jama.2011.1990.

    Article  Google Scholar 

  • Yadav, K. N., Gabler, N. B., Cooney, E., Kent, S., Kim, J., Herbst, N., et al. (2017). Approximately one in three US adults completes any type of advance directive for end-of-life care. Health Affairs (Millwood), 36(7), 1244–1251. https://doi.org/10.1377/hlthaff.2017.0175.

    Article  Google Scholar 

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Funding

This publication was made possible by the Yale School of Medicine Medical Student Research Fellowship at Yale University School of Medicine.

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  1. Gary Kopf

    Present address: , 330 Cedar Street, BB204, New Haven, CT, 06510, USA

Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT, 06520, USA

    Bryan Kaps & Gary Kopf

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Correspondence to Gary Kopf.

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The authors declare that they have no conflict of interest.

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The Yale Human Research Protection Program (HRPP) approved the study through their human investigation committees and institutional review boards. The first study was approved August 18, 2012 (Study Number 1608018190).

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Kaps, B., Kopf, G. Functions, Operations and Policy of a Volunteer Ethics Committee: A Quantitative and Qualitative Analysis of Ethics Consultations from 2013 to 2018. HEC Forum 34, 55–71 (2022). https://doi.org/10.1007/s10730-020-09426-4

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