Many Ethics Committees Are Not Following AAP Guidance
In 2019, the American Academy of Pediatrics (AAP) outlined recommendations for pediatric ethics committees.1 Ethics committees in children’s hospitals are not consistently following those recommendations, according to a group of researchers.2
“Ethics committees are critical resources that are there to help children, their families, and clinicians when ethical challenges arise in the day-to-day care of hospitalized children,” says Connie M. Ulrich, PhD, MSN, RN, FAAN, a professor of nursing and of medical ethics and health policy at Penn Nursing.
Ulrich and colleagues surveyed 117 ethics consultant leaders at children’s hospitals on their programs and practices, then analyzed the responses to assess for adherence to the AAP’s 2019 recommendations. The researchers found multiple practice gaps, including training needs; informing staff, patients, and family about ethics services; and scope of ethics service. These practice gaps could erode ethics quality and narrow ethics reach, according to the study authors.
Ethics committees can play a role in addressing quality improvement, the AAP guidelines assert. However, only 2% of ethics committees included a quality improvement representative to address systems issues.
“Ethics committees had no clearly established bridge to quality improvement mechanisms. Additionally, ethics committees were not consistently assessing the quality of their consultation services through feedback mechanisms to then improve the quality,” Ulrich reports.
The AAP policy recommends ethics committees include organizationwide ethics as part of their role, including maintaining oversight of ethical issues involving patient care. Yet only 40% of ethics committees included organizationwide ethics within their scope.
Ethics committees should be responsible for reviewing policies relating to ethical issues, and educating staff on ethical issues, according to the AAP policy. However, Ulrich and colleagues found ethics services were not consistently involved in organizational ethics initiatives, policy writing or revising, or ethics education.
The AAP guidelines recommend ethics committee members be diverse and reflect different perspectives. However, 65% of respondents said their committee did not represent the racial and ethnic diversity of the population served. Despite this, 67% of ethics committees had not created a plan to improve diversity, and 30% of ethics committees had no mechanism in place to foster diverse perspectives and viewpoints. “We need a range of perspectives to help us better understand the intricate needs of patients, families, and society at large,” Ulrich says.
Ethics committees could start by contacting diverse communities within the hospital setting to seek their input and willingness to serve on the committee, Ulrich suggests.
Patients, families, and staff should be informed on how to raise ethics concerns, according to the AAP guidelines. “There must be a method through which nurses, other clinicians, patients, and their families can be made aware of the existence of ethical consulting and that they are free to use it for any issues relating to patient care without fear of punishment,” Ulrich urges.
However, 27% of ethics committees lacked a formal method for educating hospital staff about the availability of ethics consultancy services. “There could be a formal presentation to new employees during their orientation to highlight the goals of the ethics consult services and their availability to any member of the institution,” Ulrich offers.
Additionally, 19% of committees indicated patients and families are not informed about ethics consult services. “Ethics committees are invaluable resources that are often hidden in healthcare silos,” Ulrich concludes.
Ethics committees should ensure members maintain the necessary competencies to allow them to perform specific duties, according to the AAP recommendations. However, in the survey by Ulrich and colleagues, one-third of hospitals did not offer resources for the ethics committees to provide ethics education.
Lack of ethics education is a particular concern due to clinicians reporting increasing rates of burnout and distress, Ulrich says. Thirty-two percent of 5,312 physicians surveyed and 47% of 15,738 nurses surveyed reported high levels of burnout, according to one group of researchers.3
In Ulrich’s view, lack of ethics education is a contributing factor to surging levels of burnout and high turnover. “We worry that we will lose qualified clinicians because of the day-to-day ethical issues and stressors they confront, and the lack of an opportunity to discuss these issues and work through their concerns,” Ulrich says.
REFERENCES
- Moon M. Institutional ethics committees. Pediatrics 2019;143:e20190659.
- Weaver MS, Ulrich CM, Moon MR, Walter JK. Adherence to the AAP’s Institutional Ethics Committee policy recommendations. Hosp Pediatr 2023;13:e246-e250.
- Aiken LH, Lasater KB, Sloane DM, et al. Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety. JAMA Health Forum 2023;4:e231809.
In a survey of ethics consultant leaders at children’s hospitals, researchers found multiple practice gaps, including training needs; informing staff, patients, and family about ethics services; and scope of ethics service. These practice gaps could erode ethics quality and narrow ethics reach.
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