Guest Post: Danish Zaidi and Jennifer Kesselheim
Paper: Assessment of orientation practices for ethics consultation at Harvard Medical School-affiliated hospitals
Ethics advisory committees (EACs), or clinical ethics committees, fulfill an important role in hospitals, providing ethics consultation, contributing to hospital-wide policies, and educating staff on ethical dimensions of medical practice. Our study built upon a central question: what qualifies one to serve on these sorts of committees? It’s a question with added relevance to us as authors: Danish Zaidi was part of the inaugural class of the Harvard Medical School Master of Bioethics program and Jennifer Kesselheim is an EAC co-chair and the founding director of the Harvard Medical School Master of Medical Sciences (MMSc) in Medical Education program. We studied how EACs recruit and educate members of their committees. In particular, what orientation practices were use in educating new members of EACs and how did members perceive confidence were member in fulfilling their duties on the other end of their “orientation”?
In recent years, the American Society for Bioethics & Humanities (ASBH) has made efforts to improve and standardize practices in ethics consultation across medical institutions. The ASBH has published two foundational books regarding ethics consultation and recently their Board of Directors approved the development of a healthcare ethics consultation (HCEC) certification program. Such efforts allude to a desire for standards in ethics consultation. As such, we turned to the ASBH Core Competencies in Healthcare Ethics Consultation to identify areas that we felt committee members should have familiarity with, using these competencies as metrics to develop our survey instrument.
Given the pilot nature of our study, we kept the sample size local—including only hospitals within the Harvard Medical School network of affiliates. These ten teaching hospitals vary from large, research-heavy institutions to smaller, more community-focused medical centers.
Our study resulted in two key findings. First, orientation practices in EACs for new members are heterogenous and sometimes inadequate. Second, members of EACs exposed to ASBH core competencies felt more prepared in performing consultation duties. Neither of these findings is surprising. There is no standard pedagogy to which EACs adhere, and therefore training of new EAC members exhibits significant variability. The initials steps that the ASBH has taken to address this issue have been of some benefit, with those exposed to the core competencies responding with improved perceptions of preparedness in ethics consultation. But far more work remains to reevaluate and restructure orientation practices for new members of EACs.
Most of the EACs we surveyed had no process for recruitment, nor any formal orientation for new members. This is concerning given the expanding role of EACs in medical institutions; as medical technologies grow increasingly promethean and patient coverage increasingly complicated, questions on end-of-life care, IVF, dialysis, crisis management, etc., are more common and demand legitimate answers. We must ensure that the people tasked with providing sound ethical guidance have relevant background and training to provide it properly. This could mean the development of a centralized, online portal of resources for EACs to join into, or a certification process for EAC members as suggested by the ASBH. Of course, these ideas are limited by funding. The medical community must therefore think of ways to fund this work—this is particularly true given the volunteer nature of EACs.
Ultimately, our pilot study was the first of its kind to assess satisfaction with ethics education and perceptions of preparedness for members of hospital ethics committees. Obviously, more work remains. Our sample size, for one, is small. We hope to expand this study to a larger and more diverse group of respondents in order to draw better conclusions and posit more generalizable recommendations for pedagogy. Moving forward, we hope this work can serve as a springboard for continuing conversation and research in the area of ethics education and ethics committee work. Hopefully, medical institutions can soon appreciate the need for funding and improving the education, standards, and work of EACs.