HOSPITAL ETHICS COMMITTEES Bioethics HSM 511 Kentucky School of Public Health

Mission Hospital Ethics Committee To create a mechanism to allow the patient or the patient’s designated representative to participate in the consideration of ethical issues that arise in the care of the patient; to provide an organization and mechanism for the consideration of ethical issues arising in the care of patients; and to provide education to care givers and patients on ethical issues in health care. University of Kentucky Hospital

Bioethics Issues: Past and Present Defining Death Foregoing/Withdrawing Treatment Permanently Unconscious Patients Withholding Food and Fluids In Vitro Fertilization Surrogate Parenting Fetal Tissue Research Euthanasia, Active and Passive Abortion Genetic Engineering Assisted Suicide Organ Transplantation Do Not Resuscitate Orders Informed Consent Access to Care/Indigent Care Allocation of Scarce Resources Cloning University of Kentucky Hospital

Brief History of the Bioethics Movement 1962Kidney Dialysis --”Patient Selection Committees” 1968 Definition of Irreversible Come (Brain Death) by ad hoc Committee of Harvard Medical School 1976Karen Ann Quinlan --Prognosis Committees” President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research Early 80’sEthics Committees Emerging: 1981Less than 1% of Hospitals % of Hospitals Today75% of Hospitals 1982Baby Doe Care (esophageal atresia) 1989 Nancy Cruzan – right to die; removal of feeding tube University of Kentucky Hospital

Joint Commission on Accreditation of Health Care Organizations Standard: “Patient Rights and Organizational Ethics” Promote consideration of patient values and preferences including decision to continue treatment Recognize hospital’s responsibilities under the law Inform patients of their responsibilities in the care process. Manage the hospital’s relationships with patients and the public in an ethical manner. University of Kentucky Hospital

UK Hospital Ethics Committee Membership Profile: 7Physicians 1Dentist 6Nurses 1Social Worker 1Philosopher 1Clergywoman 2 Attorneys 1Hospital Administrator 20 University of Kentucky Hospital

Hospital Ethics Committee Membership Joan Callahan, Philosophy Nirmala Desai, Pediatrics Alan Howard, Family Nurse Liaison Dayna Matthew, Attorney Donna Farrar, Pastoral Care David Bartley, Nursing Robert Benvenuti, UK Compliance Officer Carol Dickey, Nurse (Staff Education) Vincent Mullen, Psychiatry Johnnie Leonard, Nursing David Nash, Dentistry, Chair Michael Rie, Anesthesiology Randy Schleenbaker, Physical Medicine and Rehabilitation Lin Dudik, Social Work David Heistand, Resident Daniel Beals, Pediatric Surgery Heinrich Werner, Pediatrics Karen Stefaniak, Chief Nursing Officer, Hospital Administration University of Kentucky Hospital

Responsibilities of Hospital Ethics Committee Education - facilitate educational opportunities for health care professionals, patients, and their families. Consultation - provide consultative services regarding ethical issues pertaining to a specific patient. Policies and Procedures - discussion and evaluation of policies and procedures having ethical implications. University of Kentucky Hospital

Education University of Kentucky Hospital

Principles of Patient Care Each patient shall be treated as a whole, irreplaceable, unique and worthy person. The patient’s safety, health, or welfare shall be protected and shall not be subordinated to organizational, staff, educational, or research interests or to any other end. University of Kentucky Hospital

Principles of Patient Care (cont.) Behavior reflecting the dignity, responsibility and service orientation of health care professions worthy of the public’s respect and confidence, shall be practiced by all individuals. Each patient shall have a responsible attending physician or dentist. University of Kentucky Hospital

Principles of Patient Care (cont.) The privacy of the patient and the confidentiality of every case and record shall be maintained. Patients and/or responsible family shall be informed at all stages of care about personnel responsible for the patient care, treatment plans, and activities for the patient, facilities and services available to the patient, and responsibilities of the patient and family. University of Kentucky Hospital

Informed Consent Respect for Autonomy Beneficence University of Kentucky Hospital

Advance Directives

Consultation University of Kentucky Hospital

Policies and Procedures University of Kentucky Hospital

Withholding/Withdrawing Potentially Life Sustaining Treatment -- Hospital Policy -- University of Kentucky Hospital

Levels of Support (Do not resuscitate orders) Level 1Full support, including CPR Level 2Full support, excluding CPR (DNR) Level 3Modified support, excluding CPR (DNR) May include: ventilation, entral feeding, dialysis, antibiotics, etc. University of Kentucky Hospital

Guidelines on Pain Control for the Dying Patient University of Kentucky Hospital

Resource Materials for a Establishing A Hospital Ethics Committee University of Kentucky Hospital

Our Committee Can Present Programs On: Basic Principles of Bioethics Withholding/Withdrawing Policies Futile Treatment Informed Consent Managed Care Ethics Consultation Competencies and with adequate notice and time to prepare, other topics of interest in bioethics.