A source of support. An ethics committee helps nurses do the right thing

In 1984 Archbishop Bergan Mercy Hospital, Omaha, established a nursing bioethics committee to increase its professional nurses' knowledge of applied ethics. The committee's original objectives were to (1) help nurses assume the authority and responsibility to make ethical judgements, (2) influence the development of policies on healthcare standards, (3) serve as a resource to clinicians and managers responsible for delivering high-quality nursing care, (4) develop systemwide support for nurses' participation in ethical decision making, and (5) serve as a source from which nurses could be selected to the hospital's Human Values Committee. The bioethics committee established a formal mechanism to ensure that nurses receive support when they take the initiative in ethical decisions. The nurse and the committee member from his or her department organize a "community of concern" consisting of all persons necessary to address the essential ethical components of the issue at hand.     

Exploring the role of the ethics committee psychiatrist

Healthcare ethics committees (HEC) have emerged as institutional forums for addressing bioethical dilemmas. Psychiatrists have important roles to play on these committees. Their skills in group process assessment, mental status examination, and character assessment have diverse applications. Psychiatrists can facilitate communication within the committee and as HEC-based clinical ethics consultants. HECs must be concerned with how they arrive at ethical decisions, guarding against political influence or individual monopolization. Psychiatrists can assist these efforts as organizational consultants to HECs. The perception of psychiatrists as reflective, tolerant of ambiguity, humanizing, and approachable about ethical aspects of health care suggests they would make excellent committee leaders. Psychiatrists also have important committee roles to play as ethics educators and policy makers. More demographic data is needed to investigate psychiatrist participation on HECs. Studies of how they are perceived by their ethics committee colleagues may reveal new roles and potential pitfalls for HEC psychiatrists.     

Ethics of caring and the institutional ethics committee

Institutional ethics committees (IECs) in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed IECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel Noddings, is an unacknowledged basis for IEC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for IECs.This eassay is reprinted with the kind permission of the author and the Editor of Hypatia, Margaret Simons. It originally appeared in Hypatia 4 (2) Summer, 1989; 45–56.     

Pastoral care representation on the hospital ethics committee

A recommendation for pastoral care representation on hospital ethics committees (HEC) is commonplace in the literature, but the rationale for this recommendation (and the actual practice) often is assumed or unarticulated. The authors propose a holistic anthropology which acknowledges the bodily, psychological, and spiritual aspects of all persons as a starting point for discussing the reasons for pastoral care representation. The spiritual aspect of the human person is described together with the role of the clinical chaplain on the HEC. The qualifications, skills, and training required for the HEC representative are also provided.