Willing, but waiting: Hospital ethics committees

Consultation services are widespread, but many doctors hesitate to ask for ethics help. Questions about ethicists' training and performance persist.

By Kevin B. O'Reilly, AMNews staff. Jan. 28, 2008.

Since their rise more than three decades ago, hospital ethics committees have sought to help physicians, patients and their families resolve ethical disagreements and navigate the treacherous terrain that so often accompanies medical care at the end of life.

The role of these committees was cemented in 1992 when the Joint Commission mandated that health care organizations come up with some way of addressing ethical concerns. Ninety-five percent of general hospitals surveyed in 1999 and 2000 offered ethics consultation or were starting up a consult service.

Yet at the median, these services handled only three cases in the previous year, according to the survey of more than 500 general hospitals whose results were published in February 2007 in The American Journal of Bioethics.

The use of ethics consultation services varies widely from hospital to hospital, but physician experts and ethicists agree that they frequently are underused. That leads, they say, to increased medical costs and ugly disputes among physicians, patients and families.

Physicians' reluctance to seek aid when dilemmas arise is partly grounded in the notion that a call for help is equivalent to hauling in the "ethics police." But the problem, experts say, goes far deeper.

Too often, ethics consultants lack the resources, training and mediation skills necessary to resolve disputes and address dilemmas in a timely and effective manner. In addition, the journal article pointed out that fewer than half of consultants have any formal training, and only one in 20 has a bioethics certification or graduate degree.