Guest Post: Sarah Bates
Article: The Ethics Liaison Program: Building a Moral Community
As challenges to health care delivery increase over time, it is becoming more and more important for hospitals to maintain a strong institution-wide moral culture. But the common model of employing one or a few “ethicists” can lead to the misconception that ethics is the responsibility of those individuals alone, rather than that of all staff throughout the hospital. Meanwhile, staff members who lack dedicated time for ethics-related work, but who are interested in contributing to that work to the extent that their schedules permit, lack a means by which to do so.
The Ethics Liaison Program at Beth Israel Deaconess Medical Center (BIDMC) helps to address those problems at our institution. The 75-plus Liaisons represent clinical and nonclinical areas throughout BIDMC. They spread awareness of Ethics Programs throughout the medical center, communicate between the three ethicists and colleagues in their own work areas, and take on ethics-related projects connected to their work. By “Ethics Programs,” we mean the three-person Ethics Support Service (who conduct ethics consults) and the Ethics Advisory Committee that oversees them, as well as the Liaison Program itself.
The Liaison Program is a win-win for both the Liaisons and BIDMC Ethics Programs. Liaisons join a supportive community that meets monthly to discuss the ethics consults conducted that month, as well as a related journal article. In addition to those monthly meetings, Liaisons can take advantage of educational opportunities, at BIDMC and beyond: monthly Ethics Case Conferences open to all BIDMC staff; ethics-related events and presentations at affiliated institutions; and an annual three-day bioethics course through the Harvard Medical School Center for Bioethics. Liaisons also benefit from mentorship and support to complete their projects. The Liaison Program facilitates as much ethics-related work as the Liaisons have time and inclination to complete.
The Liaison Program strengthens the moral community of BIDMC. Monthly meetings facilitate friendships among Liaisons, who come from both clinical and nonclinical areas throughout the hospital, breaking down departmental silos. The Liaisons also bring vital diversity to Ethics Programs, both as Liaisons and through their recruitment to the Ethics Advisory Committee.
The Liaison Program also facilitates both increased output and higher-quality work across Ethics Programs. The three-person Ethics Support Service does not have the capacity to take on the kinds of projects that the Liaisons complete or to integrate fully into each Liaison’s work environment. Liaisons therefore provide the Ethics Support Service with a more complete picture of the ethics issues in their work areas than the ethicists would otherwise have gotten. Furthermore, Liaisons can serve as sounding boards for colleagues who have ethics-related questions, and those conversations can resolve situations before they rise to the level of ethics consults. The Liaison Program also promotes long-term sustainability of, and institutional memory within, Ethics Programs. Liaisons do not have fixed terms, and their long-term involvement in Ethics Programs strengthens institutional memory of past cases. The Liaison Program thereby makes a valuable contribution to our institution in the realm of preventive ethics.
The Liaison Program also promotes both awareness and understanding of Ethics Programs throughout the institution, by making staff more aware of what is and (and is not) an “ethics issue.” Many ethicists struggle with widespread misconceptions on that score in their institutions, and the Liaison Program has helped with that at BIDMC. Liaisons’ colleagues might be uncomfortable asking an ethicist they don’t know personally what ought to trigger an ethics consult or what constitutes an ethics issue; those people might be more comfortable talking to a Liaison whom they already know and work with.
The Ethics Liaison Program has provided those benefits to the moral culture at BIDMC; we hope that people interested in or working in ethics at other institutions might find our model useful to establish similar programs. Although BIDMC is a large academic medical center, we believe that this model could work well at smaller institutions and community hospitals, because it specifically addresses issues that those institutions so often grapple with, such as the lack of sufficient dedicated time for ethicists to conduct ethics-related work. Ethics Liaison Programs provide a means to put energy and interest in ethics to use, through building the moral culture of the institution.