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Birth of a network.

Birth of a Network

Ethics committees are developing at a remarkable pace. In 1982, only one percent of American hospitals had established these committees; today, over 60 percent of hospitals with 200 beds or more have them. Nursing homes and dialysis centers are organizing ethics committees as well. A movement that started in a small way is becoming large and significant.

A striking feature of this spurt in growth of ethics committees is that we know little about the real phenomenon behind it. This sparsity of accumulated knowledge about how ethics committees function allows veteran committees to duplicate the work of their neighbors and leaves fledgling committees at a loss over howto constitute themselves and proceed.

Moreover, ethics comittees are challenged to face distinctive issues today, even as they attempt to resolve many of the older, lingering ones. Can ethics be done by committee and, if so, what sort of ethics should they do? Do these comittees represent the patient or the community? Will they alter the traditional role of the family in medical decisionmaking? now that committees have gained experience, should their recommendations have mandatory force?

While many are familiar with ethics committees and the issues they face, it is worth restating their purposes here. Ethics committees are interdisciplinary groups within health care institutions that advise about pressing ethical problems that arise in clinical care. A primary assumption on which they are founded is that cooperative, reasoned reflection is likely to assist decisionmakers to rech better conclusions. These comittees provide information and education to staff and surrounding communities about ethical questions, propose policies related to ethically difficult issues, and review patient care situations in which ethical questions are at stake. Burgeoning ethics committees keenly feel a need to share experiences and resources in order to fulfill these purposes.

The Ethics Committee Network


In response to this need, The College of Physicians of Philadelphia, with The Hastings Center and a network of ethics committees in the greater Philadelphia area, is mounting a project on institutional ethics committees. This effort, known as the Ethics Commitee Network Project, is funded by the William Penn Foundation of Philadelphia and is designed to provide a solid base of information and materials for ethics committees and to coordinate their activities at both regional and national levels. The project will assist in the development of a model network of ethics committees in the Philadelphia area and will apply the exprience of this group nationally. In turn, the regional network will benefit from knowledge gleaned from ethics committees around the country. The project will be directed by Bartholomew J. Collopy, Associate for Ethical Studies at The Hastings Center.

An exchange among ethics committees nationally will be furthered by the twice-yearly publication of a special section of the Hastings Center Report devoted to ethics committees, of which this is the first. It is edited by Cynthia B. cohen, a philosopher and lawyer who teaches at Villanova University and is an Adjunct Associate at The Hastings Center, and Thomasine Kushner, a philosopher at the University of California in Berkeley. The section will report on distinctive issues that ethics committees currently face, and will provide updates on the law, literature, networks, and educational programs around the country.

Other project activities will include national conferences, development of teaching and bibliographic materials, and preparation of a roster of consultants to ethics committees. Ultimately, organizers of the project hope to create a network through which ethics committees can assist one another to broach and resolve some of the complex questions they face.

The Philadelphia Story

The Delaware Valley Ethics Committee Network is a coalition of ethics committee representatives from the greater Philadelphia are working to improve the efforts of these committees by sharing information and perspectives about ethics committees and the law in patient care. our group includes members of committees at some twenty-one facilities, which range from small community hospitals in rural areas to urban tertiary care centers affiliated with universities. Four regional directors coordinatinate our work: Janet Fleetwood, Ph.D., of The Medical College of Pennsylvania, Willard Green, Ph.D., of Hahnemann University Medical Center, David G. Smith, M.D., of Temple Univesity School of Medicine, and Todd Sagin, M.D., J.D., Abington Memorial Hospital.

We began to meet in March, 1987 and focused on educational programs initiated by various committees. We plan to develop and test educational packets in conjunction with The Hastings Center staff and are also compiling local policies on withholding and withdrawing treatment, testing and care of AIDS patients, and Do-Not-Resuscitate orders. Publication of a newsletter will keep members informed of our progress in these areas.

Early in the life of the network it became apparent that procedures for case review vary widely in this region. Our hope is to examine some of the theoretical difficulties that review poses, to facilitate clear communication during review, and to develop distinct processes for it. Our goal is not to ensure identical products of review, but to encourage consistency and fairness across area committees.

Probably our most ambitious project to date was our first regional conference at The College of Physicians of Philadelphia on December 4, 1987 which focused on medical, legal, and moral issues involved in the use of advance directives for withholding and withdrawing life-sustaining treatment.
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Title Annotation:Ethics Committee Network Project
Author:Cohen, Cynthia B.; Fleetwood, Janet
Publication:The Hastings Center Report
Date:Feb 1, 1988
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