The Bioethics Center

Ohio Health Care Ethics Committees Information (OHECI) Project

Report on Second Ohio Healthcare Ethics Committees Information (OHECI 2) Project

(From BIO Quarterly, Vol. 15 No. 4, Winter 2004)
Allyson Robichaud, Ph.D. & Emma Hasenstaub

In the first Ohio Health Care Ethics Committees Information (OHECI 1) Project, the survey disseminated to healthcare ethics committees (HECs) throughout the state of Ohio, and completed by the Chair of the HEC, dealt only with the constitution and governance of HECs.[1] The second Project (OHECI 2) survey, sent to the same institutions and again completed by the HEC Chair (though with attrition, this may not be the same person who responded to OHECI 1), attempts to deal with the constitution and operation of hospital ethics committees. Both phases of this project were endorsed by the BENO Board of Trustees.

Of the 170 surveys sent to chairs of hospital health care ethics committees, 80 surveys have been mailed back to us. This is a response rate of 47% and only slightly lower than that of the first questionnaire (53% return rate).

The preliminary report from the OHECI 1 Project found that end-of-life issues were raised frequently in case consultations (93%). Sixty-six percent of the OHECI 2 respondents state that most or all of the cases they reviewed over the last year involve end-of-life issues and 22% of the cases listed as “most difficult” by respondents were those involving end-of-life issues. Included in this 22% is the listing of “patient versus family wishes at end of life.” Futility and non-effective treatment were listed by 19% of the respondents. Included in this 19% are the responses noting family demands for non-effective treatment, conflict resolution in such cases and helping families recognize futile treatments. Interestingly, 10% of the HECs report none of the cases reviewed over the last year were end-of-life cases.

In OHECI 1 more than half of the HECs reported a need for more educational development. The OHECI 2 survey shows in the past six months, 62.5% of the HECs responding have sponsored or conducted educational programs. Thirty-three percent of the programs reported dealt covered of end-of-life issues. The second most commonly cited topics are Do Not Resuscitate (DNR) Orders and Advance Directives (each accounting for 14% of the reported programs).

Looking at what methods are used in HEC education, 45.5% of the respondents report they sometimes (‘sometimes' reflects the original wording of the survey) conduct case analyses; sometimes perform retrospective quality reviews of cases (56%); sometimes engage in discussion of journal articles are sometimes discussed (42%); sometimes discuss legal and news items. While this indicates educational development occurs in many HECs, a significant number report they rarely engage in these activities, with, for example, 57.8% responding they rarely review current legal/news items.

Over half of the responding committees have mission statements. HECs have been busy participating in the creation of documents related to hospital policy and guidelines. Over half of the participating HECs were involved in the development of end-of-life care guidelines, though more (69%) participated in developing such documents related to DNR orders. Thirty-two percent of the committees participated in developing nutrition/hydration guidelines. Respondents were asked if they would provide samples of mission statements and policies their HECs participated in developing; only 54% report having a mission statement. Fifty-four percent of the respondents said that they would be willing to provide documents (either with or without identifiers), and we have received 37% of these documents (16 out of 43). In total, 20% of the respondents have provided documentation to be housed in the library.

When asked, “If you could make one change in your ethics committee to make it more effective, what would it be?,” thirty-two different possible changes were stated, many of which were made by a single respondent. The most commonly cited change that would improve the committee: more physician involvement (19%). However, of the 32% of respondents who say that their committees are dominated by one or two members, 59% cite physicians and surgeons as the most common professions for those who dominate the meetings.

[1] For report see BIO Quarterly, Vol. 12 No. 4, Winter 2002:6

Preliminary Report on Ohio Healthcare Ethics Committee Information Project

(From BIO Quarterly, Vol. 12 No. 4, Winter 2002)

By Allyson Robichaud, PhD
Editor

The Ohio Hospital Ethics Committee Information (OHECI) Project was initiated Spring semester 2002 with financial support from the Office of the Dean of the College of Arts and Sciences, Cleveland State University. The Department of Philosophy provided the project with the help of graduate assistants Jackie Herrick and Ken Barber. James Barlow served as a consultant for the project. The (OHECI) project is endorsed by the Board of Trustees of the Bioethics Network of Ohio and is directed by the Bioethics Center in the Philosophy Department at Cleveland State University. If you have comments, suggestions, or questions about the project please contact, Allyson Robichaud, co-Director, a.robichaud@csuohio.edu or (216) 687-3906.

Of 172 questionnaires sent out to chairs of hospital health care ethics committees, 90 have been mailed back to us, for a 52% return rate.

Initial comparison with "A National Study of Ethics Committees," by Glenn McGee, Arthur Caplan, Joshua Spanogle and David Asch in the Fall 2001 issue of The American Journal of Bioethics, shows that the responses we are seeing here in Ohio, are comparable to those in the national survey. However, there are a couple of interesting differences worth investigating. For example, our sample so far shows 60% of the ethics committees allow consult requests from outside agencies, nearly double that of the national survey.

The surveys returned provide responses from a good variety of types of institutions. The average number of beds reported is 256. Fifty percent report at least some teaching takes place in their institution.

We queried how decisions were made and 67% report decisions are determined by consensus, as opposed to a majority vote. Almost half report meeting monthly and very few (8%) only as needed. On average 70% of their membership is in attendance for meetings.

Most report that patient autonomy/competency issues (90%) and end-of-life issues (93%) are frequently raised in case consultations, with issues concerning communication commonly occurring as well (83%). Over 90% of those responding allow for patients or families to request a case consult and 74% report allowing patients to attend the sessions held.

While 83% think their committee is well-supported and effective, 58% report their committee could use additional resources and development. More than half of the HECs report a need for more educational development.

 

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