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THE ROLE OF ETHICS COMMITTEES

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Sample ethical dilemmas. Workshop exercise ... Functioning of the ethics committee in dealing with ethical dilemmas ... Ethical dilemmas will never leave us. ... – PowerPoint PPT presentation

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Title: THE ROLE OF ETHICS COMMITTEES


1
THE ROLE OF ETHICS COMMITTEES
  • Janet Farrell
  • Thailand Accreditation Consultant

2
CONTEXT
  • Large teaching university hospital-
  • Ethics committee studies the ethical implications
    of research projects and approves these.
  • Moderate size and small hospitals-
  • Professional ethical situations
  • All hospitals-
  • Ethical dilemmas

3
What is an Ethical Dilemma?
  • Definition
  • Ethics the study of moral standards and moral
    judgment.
  • Dilemma
  • Any situation requiring a choice between
    unpleasant alternatives.
  • Any serious problem that is difficult to solve.

4
Sample ethical dilemmas
  • Workshop exercise

5
Principles of ethical decision-making
  • Some principles that are relevant to health care
  • Autonomy
  • Beneficence
  • Nonmaleficence
  • The common good
  • Double effect
  • Informed consent
  • Proportionate and disproportionate
  • Integrity and totality

6
Why we use the ethical principles?
  • Biases
  • Definition
  • Partiality
  • Slanting in one direction

7
Why we use the ethical principles?
  • We must set aside our individual biases and make
    decisions using the ethical principles.
  • Not all principle can be applied to all dilemmas.

8
Principle of Autonomy
  • Capacity for self determination
  • Implies that the patient should be free from
    coercion in deciding to act. Others are obliged
    to respect the decision and to tell the truth.
  • Informed consent.

9
Principle of Autonomy
  • This can be overridden by competing moral
    considerations.
  • Choices endanger public health
  • Potentially harm others
  • Require a scare resource.

10
Principle of Beneficence
  • Traditionally understood as the first principle
    of morality.
  • Do good and avoid evil.

11
Principle of Nonmaleficence
  • first do no harm
  • Doing no evil
  • Often considered a normal result of beneficence.
  • If one cannot cause good without causing harm,
    then one should not act at all.

12
Principle of Double effect
  • An action has two effects intended as good, and
    yet there is an unintended yet foreseen evil
    effect.
  • Used in conflict situations where avoiding harm
    would required no action.
  • Used when the best actions may have some harmful
    results.

13
Principle of Double effect
  • One need not abstain from the good action that
    has foreseeable bad effects, depending on the
    moral criteria
  • It must be a good action (within your heart)
  • Direct intention is to avoid the harmful effects.
  • Beneficial effects must not be achieved by means
    of the foreseen harmful effects
  • The benefit must be equal to or greater than the
    foreseen harmful effects.

14
Principle of Common Good
  • Conditions in society that allow individuals to
    achieve human and spiritual growth.
  • There are three elements
  • Respect for persons
  • Social welfare
  • Peace and security.

15
Principle of Informed Consent
  • The right of a competent individual to advance
    their own welfare.
  • There are four requirements
  • Adequate disclosure of information
  • Patient freedom of choice
  • Understanding of the patient
  • Capacity for decision-making.

16
Principle of Proportionate and Disproportionate
Means
  • Proportionate means there is a hope of benefit
  • Disproportionate means there is no hope of
    benefit.
  • It arises from the general obligation to save
    life.
  • It guides individuals in weighing of benefits and
    burdens.
  • When medical treatment constitutes disproportion,
    is when one is no longer obliged to undergo the
    treatment.

17
Principle of Integrity and Totality
  • Integrity refers to each persons duty to
    preserve a view of the whole person.
  • Totality refers to the whole body and spiritual
    nature of human life.
  • These dictate the well being of the whole person.

18
Functioning of the ethics committee in dealing
with ethical dilemmas
  • First educate the members of the ethics committee
    regarding the ethical principles.
  • To educate and provide support to the teams of
    the hospital in making decisions that are
    consistent with the patients values and goals.
  • Development or have input into ethical policies
    e.g. CPR, restraints, research. etc.
  • Make recommendations (not decisions) that add
    substantive guidance to the decision making
    process.

19
Method of supporting teams
  • Join the hospital teams to provide expertise and
    a recommendation.
  • Clearly articulate the rational as to why one
    course of action is permissible or preferable
    within the ethical perspective and the clinical
    circumstances of the particular case.
  • Some members to be available on short notice
  • Keep minutes of activities

20
Steps to be taken to guide the processStep 1
  • Identify the right questions
  • Why was the consultant called?
  • What are the right questions to be asked?

21
Step 2. Identify the Facts
  • Patient diagnosis and prognosis
  • Patient values and goals
  • Legal issues and laws
  • Professional standards and ethics
  • Hospital policies and values

22
Step 3. Identify stakeholders
  • Who is affected by the decision to act?
  • Who is MOST affected by a particular decision?

23
Step 4. Identify Relevant Moral/Ethical
Principles
  • Beneficence, autonomy, informed consent, common
    good, double effect etc.

24
Step 5. Consider Alternate Options
  • Are the identified goals of treatment appropriate
    considering the patients clinical situation?
  • Are there other options than to treat or not
    treat?

25
Step 6.Arrive at and Justify the Recommendation.
  • Get the people involved to take turns expressing
    different points of view.
  • Summarize points of agreement.
  • Debate and discuss points of agreement until a
    decision is reached that everyone can live with.
  • Allow some to opt out if necessary.
  • Consider if the intended results are consistent
    with relevant moral/ethical norms.

26
Step 7. Review and Follow-up
  • Were all parties comfortable with the decision
  • Were people with expertise consulted.
  • Was informed consent obtained before
    implementation.
  • Were appropriate steps taken in a timely manner?

27
CONCLUSION
  • Ethical dilemmas will never leave us.
  • Ethics committees can and should provide support
    to the PCTs to try to deal with these difficult
    problems
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