Functions, Operations and Policy of a Volunteer Ethics Committee: A Quantitative and Qualitative Analysis of Ethics Cons
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Functions, Operations and Policy of a Volunteer Ethics Committee: A Quantitative and Qualitative Analysis of Ethics Consultations from 2013 to 2018 Bryan Kaps1 · Gary Kopf1,2 Accepted: 9 September 2020 © Springer Nature B.V. 2020
Abstract Few institutions have published reviews concerning the case consultation history of their ethics committees, and policies used by ethics committees to address inappropriate treatment are infrequently reviewed. We sought to characterize the operation of our institution’s ethics committee as a representative example of a volunteer ethics committee, and outline its use of a policy to address inappropriate treatment, the Conscientious Practice Policy (CPP). Patients were identified for retrospective review from the ethics consultation database. Patient demographics, medical admission information, and consultation information were obtained from the medical record. Consultation notes were analyzed with directed content analysis. The use of the CPP was documented in each case. Groups of interest were compared via twosample t-tests. There were 178 consultations between 2013 and 2018. The majority originated from medicine services (N = 145, 82.4%). The most common consultation reasons were end-of-life balances of acute and palliative care (N = 85, 47.2%), best interest standard (N = 82, 46.1%), medical futility (N = 68, 38.2%), and code status and intubation status (N = 67, 37.6%). Average age was 65.5 years and average hospitalization before consultation was 51.4 days. 92 patients (53.3%) had a code status change that occurred after consultation. A policy to address inappropriate treatment (CPP) was used in 42 (23.9%) of the consultations. Bivariate analysis demonstrated a reduction in policy use over time, with use in 32.1% of consultations from 2013 to 2016 and 11.4% of consultations 2017–2018, p = 0.002. End-of-life issues were the most common reason for consultation. Our consultation volume was lower than previously-published reports. A policy used to address inappropriate treatment was frequently used, although use decreased over time. Keywords Clinical ethics consultations · Futility policy · Inappropriate treatment · Retrospective review
* Gary Kopf [email protected] Extended author information available on the last page of the article
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Introduction Although research concerning single institution clinical ethics committees has been expanding over the past decade, there is still limited insight into differences between ethics committees at different institutions (Robinson et al. 2017b; Wasson et al. 2016; Bruce et al. 2011; Swetz et al. 2007; Tapper et al. 2010; Au et al. 2018). Recently, many involved in ethics committee operations have suggested that ethics committees should be adopting standardized protocols to conduct committee consultations, but compliance with and effectiveness of these protocols is unclear and infrequently evaluated (Post and Blustein 2015; Kodish et al. 2013; Siegler 2019; Fox et al. 2007a). Even less frequently eva
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