Having spent most of my career in a major hospital system, bioethics committees were a given within the hospital management structure. These committees play an increasingly important role in decision-making as medical advances, new technologies and health reform present new opportunities and challenges for clinicians and administrators.

 

So it was surprising to me to learn that in the long-term care sector bioethics committees are not the norm. Eldercare and end-of-life care often involve complex and nuanced decision-making that it seemed to me bioethics committees would be of great value. I was inspired to establish a bioethics committee for the seven rehabilitation and skilled nursing centers that are part of Plaza Health Network here in Miami, and want to encourage others in the long-term care sector to consider the value of such committees.

 

In our process of establishing a bioethics committee, we were fortunate to have “in our back yard” the invaluable guidance and expertise of Kenneth W. Goodman, Ph.D., founder and director of the University of Miami Miller School of Medicine’s Institute for Bioethics and Health Policy.

 

The rise of bioethics committees, especially in acute care settings, can be attributed in part, to the tremendous media attention sparked by high profile end-of-life controversies: Karen Ann Quinlan in the 1970s and more recently Terry Schiavo are two examples. Such cases demonstrate the need for including multiple perspectives and expert opinions when making care decisions.

 

Now all hospitals have a bioethics committee required by accreditation, but in long-term care it’s not so prevalent. Ethical issues are an inherent part of long-term care. Strong bioethics committees can serve an educational function for staff, as a supportive resource for administrators, clinicians, family members and others involved in the caregiving process.

 

It’s important bioethics committees include diverse perspectives. In structuring our committee, we reached out to doctors, nurses, social workers, clergy, patient representatives, and other healthcare professionals. Diversity of experience and expertise proves valuable especially when you think about the many types of situations that can come before a long-term care bioethics committee for review. Problem areas can range from DNR orders, withdrawing and withholding treatment, valid consent and refusal of treatment or sustenance, medical futility, truth telling and prognostication, health care reform and managed care, resource allocation, public health emergencies, advance directives confidentiality, surrogate decision making, patient safety and health information technology. The list goes on from there.

 

Plaza Health Network’s bioethics committee serves the management, staff, residents and family members in various capacities. A patient or patient representative can request input from the committee because there is concern about the decisions being made about the resident’s health and or treatment. A family caregiver can seek counsel when trying to resolve disagreements in care decisions. A clinician at the center can seek the perspective of a clergy member about the role of faith in a particular resident’s end-of-life care plan. An administrator can gain insight about the impact of regulatory changes on care plans. The possibilities are endless, but here is one example of a situation that would benefit from review by a bioethics committee:

 

A resident will soon be discharged from a psychiatric unit and wants to return to the nursing facility where she lived before being transferred to the psychiatric unit. The family is requesting that she return to the facility as her previous “home”. The nursing facility does not believe she should return. Staff are concerned that the disruptive behavior that caused the transfer to the psychiatric unit will continue, adversely affecting other residents and potentially causing unsafe situations for the returning resident.

 

Clearly there is an important role for bioethics committees in contributing to ethical, high-quality care in long-term care settings, just as there is in acute care settings. I encourage every long-term care provider to explore this management tool, and to reach out to others who have been through the process for guidance and advice.

 

For those interested in furthering their knowledge of the roles, responsibilities, and results of Bioethics Committees below is a list of resources:

– Florida Bioethics Network

– Florida Nurses Association “Ethics Special Interest Group”

– Florida Bioethics Network

– Bioethics/Biodefense – American Nurses Association
                

– American Society for Bioethics and Humanities (ASBH)


– American Nurses Association Guide to the Code of Ethics for Nurses

– Florida Statute 765, ‘Health Care Advance Directives’