Making the case for education
Making the case for education
Committee meetings make best classrooms
(Editor's note: This is the last of a three-part series on ethics in the 21st century. Last month, Medical Ethics Advisor discussed how hospital ethics committees could develop a business code of ethics to comply with regulatory standards for organizational ethics. In February, MEA offered tips and ideas on fostering truth-telling among physicians and staff. This month, we examine how ethics committees can offer specialized education for committee members.)
You've just been appointed ethics committee chair at your facility. The administrator tells you that the committee was formed days ago, and part of your responsibility is to educate members on bioethical issues and the committee's role within the facility. That example may sound extreme, but it happens all too frequently. The good news is that the ethics committee can serve the facility simply by meeting, and in all likelihood, the committee will, in effect, educate itself, say experts who spoke with Medical Ethics Advisor.
"I think the issue of how ethics committees self-educate is an important one, and one that our committee has been discussing recently," says John Z. Sadler, MD, professor of psychiatry at University of Texas Southwestern in Dallas and co-chair of the ethics committee at Parkland Memorial Hospital, also in Dallas. In fact, the monthly ethics committee meeting is where most of the members receive their education, he says.
"Our committee meets monthly at lunchtime and performs the usual educational, policy, and consultation functions as other hospital ethics committees. The meetings proper are always an occasion for education in that our tasks bring important problems that we all have to address," he adds.
The problems brought to the committee often require the members to research literature on the topic. "For instance, we recently had a raft of consultations concerning discontinuing treatment of patients who had a persistent vegetative state [PVS] for only a week or two. This prompted the neurosurgeon committee member to review the issue of how long PVS must be PVS to diagnose it and act accordingly."
The neurosurgeon in turn presented his findings to the committee, and the committee will educate staff and the community about the issue, he says. Any committee member can include information in the upcoming meeting; for example, they often submit reading materials to the committee chair to be distributed with the meeting agenda.
"The obvious problem with this is there's no opportunity to encourage actually reading the material. There's no discussion time planned in the meeting," Sadler says.
In addition to attending monthly committee meetings, members have a more formal educational program immediately before each meeting. "We meet at 11:30 a.m. before the noon meeting to discuss a chapter from Resolving Ethical Dilemmas: A Guide to Clinicians, written by Bernard Lo, but no longer available in print. This is our formal, ongoing self-education project, and the book expense was borne by the Parkland Health and Hospital System. We occasionally supplement the chapter with additional material."
Some committees take a slightly different approach to education and offer an additional element for new members. In addition to committee meetings, for example, new members attend an ongoing educational project called the Ethics Education Seminars program at the University of Texas Medical Branch at Galveston.
"Basically, we invite experts from various fields to make an ethics presentation to the committee at the regularly scheduled monthly meetings. We make an effort to provide handouts of current literature or any guidelines that may have been issued recently," says Michele Carter, PhD, assistant professor at the Institute for Medical Humanities at the University of Texas. Carter also serves as co-chair of the hospital's ethics committee and is one of four staff members who provide ethics consultations within the hospital. (For more on academic seminars, see story, p. 43.)
Members of the committee may make a presentation, and experts outside the facility may be asked to participate, Carter adds. "The basic responsibility for keeping this program going falls on the chairpersons' shoulders."
The University of Texas ethics program, which has been operational since 1993, has three components. The first is the ethics consultation service, and the second is clinical ethics teaching rounds. The final component is the ethics committee, and that's where the seminar program fits in. (For more on the University of Texas ethics program, see story, p. 42.)
Carter suggests using the hospital's continuing education program to help educate ethics committee members. "We all contribute to these programs on a regular basis," she says. "Ours is a well-established program which fortunately has received the respect and support of both academic and clinical leadership."
One benefit she is quick to point out, however, is the facility's affiliation with a university. "Since the Institute for Medical Humanities is right on campus, there is an abundant amount of resources available, either in our master's or doctorate program faculty in medical humanities.
"It is somewhat rare to have this level of expertise available on one campus," she adds, "and many times we are asked to give talks in the community, either to organizations trying to set up ethics committees in their facilities or to assist them with particular consultations."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.