What is the role of an ethical committee in a hospital?

The Role of Ethical Committees in Hospitals

Hospital ethics committees serve three primary functions: education, policy development, and ethical case consultation, all aimed at protecting patients from harm while enhancing the quality of healthcare delivery. 1 These committees play a crucial role in navigating complex ethical dilemmas that arise in clinical settings, providing guidance to healthcare professionals, and ensuring that patient rights and welfare remain at the forefront of medical decision-making.

Composition and Structure

Ethics committees in hospitals should have diverse membership to ensure comprehensive ethical review and guidance:

• Multidisciplinary representation: Including medical staff, nursing staff, and a wide range of age groups 2
• Lay membership: At least two or more lay persons should be included 2
• Leadership: At least one of the two positions of chairperson or vice-chairperson should be filled by a lay member 2
• Independence: Committees should operate independently from hospital management, as they "are not in any sense management arms of the NHS body" 2

Key Functions

1. Education

• Providing ethical education to healthcare professionals
• Raising awareness about ethical issues in clinical practice
• Informing staff about relevant ethical guidelines and principles

2. Policy Development

• Developing institutional clinical policies 3
• Reviewing and updating existing policies related to ethical issues
• 86% of ethics committees report involvement in ongoing clinical decision-making 3
• Addressing emerging ethical challenges in healthcare delivery

3. Ethical Case Consultation

• Assisting healthcare professionals and patients in achieving mutually acceptable decisions when ethical dilemmas arise 1
• Mediating rather than prescribing solutions to ethical conflicts 4
• Processing and analyzing complex cases using established ethical frameworks
• Providing recommendations based on ethical principles and institutional policies

Scope of Responsibilities

Ethics committees have broad responsibilities that extend to various aspects of hospital operations:

• Research oversight: Reviewing research protocols involving human subjects 2
• Informed consent: Ensuring that research subjects receive appropriate information about risks and benefits 2
• Patient protection: Safeguarding patient rights and welfare in clinical and research settings 2
• End-of-life care: Developing and implementing policies on life-sustaining treatments 5
• Compensation arrangements: Reviewing provisions for subject compensation in research 2

Operational Procedures

Ethics committees follow specific operational procedures to ensure effectiveness:

• Regular meetings: Committees meet periodically to discuss ethical issues
• Documentation: Maintaining records of consultations and recommendations
• Annual reporting: Producing annual reports to ensure transparency 2
• Protocol review: Evaluating research protocols before implementation 2
• Monitoring: Following up on significant deviations from approved protocols 2

Common Challenges

Ethics committees face several challenges in fulfilling their roles:

• Limited resources: Many committees lack resources to effectively monitor research projects 2
• Inconsistent decision-making: Variations in decisions between different committees 2
• Legal concerns: Healthcare professionals often prioritize legal considerations over ethical theory 4
• Preparedness gaps: 50% of ethics committee chairs feel inadequately prepared to address managed care issues 3
• Balancing roles: Maintaining appropriate moral and professional boundaries while providing meaningful guidance 6

Best Practices

To maximize effectiveness, ethics committees should:

• Maintain independence: Operate objectively and impartially, independent of sponsors, investigators, and authorities 2
• Ensure transparency: Make membership and working practices publicly available 2
• Provide timely responses: Establish clear response times for consultation requests 2
• Conduct follow-up: Monitor implementation of recommendations and outcomes
• Receive training: Committee members should receive adequate training on ethical principles and procedures 2

Ethics committees represent a vital mechanism for addressing ethical dilemmas in healthcare settings. By serving educational, policy-making, and consultative functions, these committees help ensure that patient care adheres to ethical standards while supporting healthcare professionals in navigating complex moral challenges.