What are the resources for dealing with ethical problems at Children's Hospital?
Boston Children’s Hospital has an Office of Ethics, two Clinical Ethicists, an Ethics Advisory Committee, an Ethics Staff, and an “on-call system” for ethics consultation. There is always an ethicist-on-call who can be reached by calling the page operator at 355-6363 or directly paging #3418.
What is the Ethics Advisory Committee?
The Ethics Advisory Committee (EAC) is a multi-disciplinary committee at Bosotn Children’s Hospital, facilitated by two Co-chairs, Jeff Burns, MD, MPH, and Charlotte Harrison, JD, MPH, PhD. The committee is comprised of approximately 35 members including representatives from such departments as medicine, nursing, patient services, medicine, surgery, social services, interpreter services, respiratory therapy, and pastoral care, as well as community representatives. Also, ex-officio participation from administration and legal counsel. Members are appointed by the Medical Staff Executive Committee and EAC Co-chairs to serve a 3-year term. The EAC meets monthly. Its goal is to provide a forum for education, discussion and guidance regarding ethical decisions.
In addition, Robert Truog, MD and Christine Mitchel, RN, MS, MTS, are Executive Faculty Director and Executive Director, respectively, of the Center for Bioethics in the Division of Medical Ethics at Harvard Medical School, which provides annual educational and research fellowships in medical ethics, an annual 3-day Harvard Bioethics Course for clinicians and ethics committee members, a monthly case-based Harvard Ethics Consortium, and regular meetings for the Ethics Leadership of the Harvard-affiliated health care institutions. For more information, email firstname.lastname@example.org.
Why do we have an ethics committee?
Health care decisions can be very complex. Advances in medical technology have given us many choices. There is so much that we can do; sometimes we need to pause and talk about what we ought to do. People don’t always have the same values and it is sometimes necessary to think about which values should determine how to care for a child and family.
That’s when an ethics committee can help, by applying ethical principles and ideas about moral responsibility to actual real-world problems. Ethics committees give advice to people facing hard choices who want to do the right thing. The ethics committee takes into account people’s values and various responsibilities, as well as ways that similar issues have been resolved in the past. It offers special expertise and experience in medical ethics. Whenever the committee gets involved, it does so with respect for patients’ rights, family privacy, and the personal nature of health care decisions.
What does the Ethics Advisory Committee do?
The Ethics Advisory Committee’s work falls into three categories: education, policy and consultation.
Education: Not everyone is an expert in medical ethics, but everyone is concerned with doing the right thing, being fair in providing health care for children. Learning more about ethics helps to fulfill that shared responsibility. The Office of Ethics staff stays up-to-date on bioethical issues, through clinical ethic literature and legal developments; arrange consultations with leaders in the field of ethics; discuss advances in medical technology that present novel ethical problems and help theEAC plan educational programs for hospital staff.
Policy: When problems are partly or primarily ethical, the Ethics Advisory Committee initiates, reviews or comments on hospital policies. For instance, the EACdeveloped apolicy on the Ethics of Redirecting the Goals of Care because many parents and staff caring for children with incurable illnesses had asked for advice on weighing the value of prolonging life as long as possible and the value of providing comfort care and a dignified death. The EAC hasalso worked on policies about children’s and parents’ rights on how to deal with intractable disagreements, decisions about resuscitation, and others.
Consultation: The Ethics Advisory Committee is available every day, at any time, throughout the year to help patients, parents and staff make decisions that involve hard choices about what they should do. The ethics committee is a “consultant” or advisor, not a decision-maker. The committee will help to clarify the ethical problem, explore alternatives, and make recommendations, but the actual decision is left up to the parents (or the patient if he/she is capable of making a decision) and the responsible staff.
How do I know when to ask for an ethics consult?
Ethics involves the concerns people have about what is morally good, right, or fair. An ethics consult should be considered when a morally troubling or complex problem occurs and the usual ways of handling it do not bring resolution.
Who may ask for an ethics consult?
An ethics consult can be requested by parents, patients or any member of the health care team.
Who do I contact for an ethics consult?
Consults can be initiated by contacting the Office of Ethics at 617-355-6920, or by paging Christine Mitchell (#1506), Charlotte Harrison (#3171), Judi Friedson (#2367), or the “ethicist on call” (#3418.)
When can I get a consult?
Consults can be requested anytime by dialing the Page Operator at 617-355-6363, and ask for the ethicist on call".
I'm not sure whether I need an ethics consult. Is there someone I can talk to just to figure out if an ethics consult would be appropriate, without necessarily putting the whole process in motion?
Yes, you are welcome to call any of the ethicists or ethics staff (listed on the back) for an informal discussion about a case or problem. This discussion may or may not lead to a formal ethics consult.
What happens in an ethics consult?
In most cases, an ethics consult involves three members of the EAC who meet with the staff directly involved in caring for the patient and with the patient and/or the family. Usually these are two or three separate meetings where the information is gathered, and people discuss their reasons for favoring one course of action or another. Then the EAC consult team meets separately to discuss the issue(s), refine an ethical analysis and provide advice and recommendation(s). The consult is documented in the patient's medical record and a copy is provided for the parents. In a few cases an ethics consultation may be discussed with the whole ethics committee, either because (1) the caregiver or patient/parent(s) request the deliberation and advice of the full committee, or (2) the ethical question is considered by the ethicist to be peculiarly difficult or novel, or (3) the ethics consult team’s deliberations about a case left them in doubt or disagreement about what to advise the staff and family. Occasionally BCH staff request comments regarding policy or practice that do not involve our meeting with patients and families.
Who takes part in the ethics consult?
All members of the care team, the patient, and the family are informed of and invited to participate in an ethics consult.
Is it necessary to inform the patient and/or the family of an ethics consult requested by staff?
Yes. The patient and family are considered an integral part of the process of ethics consultation.
What information is documented in the medical record?
The EAC consult team writes a report, including a list of who was present for each discussion, along with a summary of the pertinent issues and recommendations. The EAC consult report becomes part of the patient’s medical record. Copies of the report are given to the parents and staff who were involved in the ethics consultation. Staff members may also record the consult meeting(s) in their progress notes.
What happens after an ethics consult?
A member of the ethics consult team will discuss the team’s advice with staff and family. Ultimate responsibility for decisions about the patient's care, including ethical decisions, remains with the care team and family. Parents and staff are not required to follow the recommendations of the Ethics Advisory Committee.
What are the legal implications of consulting the EAC?
Generally it is of legal benefit to obtain an ethics consult in cases where there is concern about what is ethically right. An ethics consult is not a substitute for legal advice. If you have any questions or concerns about the legal aspects of a problem, please call the hospital’s Office of General Counsel, at 5-6800.
What are the advantages of consulting the EAC?
Though it can be difficult to bring an outsider's input into a complex case, sometimes a more objective viewpoint helps to clarify the issues and increase communication among the involved parties. The ethical implications of various alternatives are explored, which can be informative and validating to those facing morally distressing choices. Since EAC members have continuing education in biomedical ethics, and are familiar with the kinds of cases that raise ethical issues, they can be efficient and effective at exploring medically and morally complex cases and offering ideas for dealing with them.