HOSPITAL ETHICS COMMITTEES

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HOSPITAL ETHICS COMMITTEES

• Bioethics
• HSM 511
• Kentucky School of Public Health

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MissionHospital Ethics Committee

• To create a mechanism to allow the patient or the
  patients 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
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Bioethics IssuesPast 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
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Brief History of the Bioethics Movement

• 1962 Kidney Dialysis --Patient Selection
  Committees
• 1968 Definition of Irreversible
  Come (Brain Death) by ad
  hoc Committee of Harvard Medical School
• 1976 Karen Ann Quinlan --Prognosis Committees
• 1980-83 Presidents Commission for the Study of
  Ethical Problems in
  Medicine and
  Biomedical and Behavioral Research
• Early 80s Ethics Committees Emerging
• 1981 Less than 1 of Hospitals
• 1985 50 of Hospitals
• Today 75 of Hospitals
• 1982 Baby Doe Care (esophageal atresia)
• 1989 Nancy Cruzan right to die
  removal of feeding tube

University of Kentucky Hospital
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Joint Commission on Accreditation of Health Care
OrganizationsStandard Patient Rights and
Organizational Ethics

• Promote consideration of patient values and
  preferences including decision to continue
  treatment
• Recognize hospitals responsibilities under the
  law
• Inform patients of their responsibilities in the
  care process.
• Manage the hospitals relationships with patients
  and the public in an ethical manner.

University of Kentucky Hospital
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UK Hospital Ethics CommitteeMembership

• Profile
• 7 Physicians
• 1 Dentist
• 6 Nurses
• 1 Social Worker
• 1 Philosopher
• 1 Clergywoman
• 2 Attorneys
• 1 Hospital
  Administrator
• 20

University of Kentucky Hospital
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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
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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
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Education
University of Kentucky Hospital
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Principles of Patient Care

• Each patient shall be treated as a whole,
  irreplaceable, unique and worthy person.
• The patients 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
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Principles of Patient Care (cont.)

• Behavior reflecting the dignity, responsibility
  and service orientation of health care
  professions worthy of the publics respect and
  confidence, shall be practiced by all
  individuals.
• Each patient shall have a responsible attending
  physician or dentist.

University of Kentucky Hospital
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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
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Informed Consent
Respect for Autonomy
Beneficence
University of Kentucky Hospital
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Advance Directives
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Consultation
University of Kentucky Hospital
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Policies and Procedures
University of Kentucky Hospital
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Withholding/Withdrawing Potentially Life
Sustaining Treatment-- Hospital Policy --
University of Kentucky Hospital
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Levels of Support(Do not resuscitate orders)

• Level 1 Full support, including CPR
• Level 2 Full support, excluding CPR
• (DNR)
• Level 3 Modified support, excluding
• CPR (DNR)
• May include ventilation,
  entral feeding, dialysis,
  antibiotics, etc.

University of Kentucky Hospital
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Guidelines on Pain Control for the Dying Patient
University of Kentucky Hospital
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Resource Materials for aEstablishing A Hospital
Ethics Committee
University of Kentucky Hospital
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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.