Objectives

1. Describe the goal of healthcare ethics committees’ (HECs) policy-makingactivities.

2. Understand how the HEC’s purview and mission within the organization shape itspolicy-making role.

3. Suggest tools and strategies supporting HECs’ development of efective ethicspolicies.

4. Identify internal challenges and external barriers to successful policy development.

Case 1

At its annual review of the hospital’s ethics consultation activities, HEC members noted a seriesinvolving elderly ICU patients who lacked both decision-making capacity and a legally authorizedrepresentative. The HEC convened a subcommittee to propose a new institutional policyaddressing how to proceed with decision-making for these patients. The subcommittee crafteda policy that specified steps for staff to take under such circumstances. The HEC obtainedthe approval of the organization’s governing entity and implemented an education programto familiarize staff with the new policy on patients without surrogates. A year later, the HECreviewed the policy’s effectiveness, and modified it to apply to outpatients presenting withsimilar characteristics.

Case 2

A pathologist who over saw the blood bank at a large, research-oriented hospital asked the HECChair to organize a policy initiative thatwould govern tissue-based research. The context for therequest reflected the impending federal deadline for compliance with the Privacy Rule in theHealth Insurance Portability and Accountability Act, as well as growing ethical consensus thattissue-based research required informed consent from patient sources.

A member of the HEC agreed to lead the effort, assisted by a task force of over 20 employees.The task force conducted needed research into existing practices; sought recommendationsfrom literature and topic experts; drafted policy language; circulated proposed versions amongnumerous departments within the organization, including legal counsel; ushered the policy through review by organizational leadership; and eventually obtained approval by themedicalstaff and managing board. Upon their approval, the HEC’s responsibility officially terminated.