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Does Legislating Hospital Ethics Committees Make a Difference? A Study of Hospital Ethics Committees in Maryland, the District of Columbia, and Virginia

Published online by Cambridge University Press:  29 April 2021

Diane E. Hoffmann
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Extract

Nationally, the number of hospital ethics committees grew dramatically during the 1980s. The motivation for establishing such committees, however, was not only internal but included court cases, federal regulations and a Presidential Commission report urging the establishment of such committees by hospitals.

While each of these external forces added to the pressures for hospitals to establish their own ethics committees, the establishment of these committees was voluntary in every state until 1987 when the Maryland Patient Care Advisory Committee Act became effective. The Act requires all hospitals within Maryland to establish their own patient care advisory committees or ethics committees, as most hospitals refer to them. Specifically, the Act provides that at the request of a petitioner, these committees must offer advice in cases involving individuals with life-threatening conditions. The committee must consist of at least four members, including a physician, a nurse, a social worker, and a hospital's chief executive officer or designee.

Type
Article
Information
Law, Medicine and Healthcare , Volume 19 , Issue 1-2 , Spring Summer 1991 , pp. 105 - 119
Copyright
Copyright © American Society of Law, Medicine and Ethics 1991

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References

Md. Health Gen. Code Ann. 19–370 to 19–374.Google Scholar
The Act was amended and as of July 1, 1990 all nursing homes in the state must establish such committees or participate in a multi-institutional committee with a hospital or other nursing homes. Md. Health Gen. Code Ann. Sec. 19 – 374(F).Google Scholar
Copies of the survey instruments are available from the author.Google Scholar
The percentage becomes even higher if federal hospitals, which are arguably exempt from the Maryland statute, are excluded from the sample. In that case, 91% of the hospitals in Maryland have established an ethics committee.Google Scholar
Given the response rates, it is possible that the results portray a somewhat skewed picture of ethics committees in these jurisdictions. For example, it is possible that those committees that responded are more active than those that did not. Thus, responses to such questions as “How many cases did you review in the past year?” and “How many times did you meet in the past year?” may actually be higher than the figures for the entire population.Google Scholar
Responses total more than 100% as respondents may have selected more than one response.Google Scholar
Responses total more than 100% as respondents may have given more than one answer.Google Scholar
In Maryland, under the Patient Care Advisory Committee Act, a committee member may not be held liable in court for the advice given by the committee in “good faith.”Google Scholar
The five hospitals were all private, not-for-profit, general hospitals. Four of the five were teaching hospitals. Of those four, three (hospitals A, B, and D) had between 250 beds and one (hospital E) had over 500 beds. One of the four (hospital B) was a religiously affiliated hospital. The fifth hospital (hospital C) was a non-teaching hospital with between 100 and 250 beds. Letters refer to the designation in Table 17.Google Scholar
The sample of attending physicians was taken from all medical staff.Google Scholar
The sample of nurses was taken from all RNs, full time and part time.Google Scholar
This was higher than expected but may be due to a bias in responses—i.e., users of the committee may have been more likely to respond than non-users.Google Scholar
The experience of some of the non-respondents was not directly related to case consultation. For example, several respondents were committee members. The direct experience of some others included attending an “in service” explaining the committee or serving on an advisory committee that established the policies and guidelines for the hospital ethics committee.Google Scholar
This figure is based on a 1985 survey conducted by the American Hospital Association.Google Scholar
See President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment, 1983, p. 446.Google Scholar