The Role and Legal Status of Health Care Ethics Committees in the United States

Over a quarter of a century has passed since health care ethics committees (HCECs) in the United States received legal recognition as alternatives to the courts in resolving conflicts related to patient end-of-life care. By the mid to late 1980s HCECs had been established in over half of U.S. hospitals and had received a certain legitimacy in the health care system. Given their age and growth one could characterize them developmentally as emerging from adolescence and establishing themselves in young adult-hood. As a result, we might expect that they would have resolved the identify crisis characterizing the adolescent years. Yet, HCECs in the United States remain somewhat amorphous. In part, this may be due to their relative lack of legal status. In most U.S. jurisdictions HCECs remain unregulated and lack homogeneity in structure and operation. To the extent that they share common characteristics, these committees are multi-disciplinary in membership and exist to address ethical dilemmas that occur within health care institutions. Early on in the evolution of HCEDs, judges, in several judicial opinions, encouraged the development of these committees, and two states adopted statutes or regulations that provided them with legal status. Until recently, however, HCECs in most states have been able to develop in a variety of ways and perform a range of functions with limited legal authority or oversight. In the last few years, a handful of states have passed laws giving HCECs legal authority to make certain kinds of decisions. While these states remain in the minority, HCECs in most states serve a role as a mechanism for “alternative” dispute resolution, particularly in cases involving end-of-life care. This chapter reviews both the history of HCECs in the United States and their legal evolution

A code of ethics for health care ethics consultants: Journey to the present and implications for the field

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here

The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain

In general, women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. The authors investigate this paradox from two perspectives: Do men and women in fact experience pain differently - whether biologically, cognitively, and/or emotionally? And regardless of the answer, what accounts for the differences in the pain treatment they receive, and what can we do to correct this situation

Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both distributive and recognitive justice. The disability rights movement\u27s demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision-making related to their interests, including in crisis planning before, during, and after a pandemic like Covid-19

Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision-making related to their interests, including in crisis planning before, during, and after a pandemic like Covid-19

Responding to Abusive Patients: A Primer for Ethics Committee Members

Interactions with abusive patients are not uncommon in health care settings, Emergency Departments (EDs) in particular. The Bureau of Labor Statistics reported that in 2000, 48% of all non-fatal injuries from occupational assaults and violent acts occurred in health care settings (U.S. Department of Labor, 2001). ED settings are challenging for various reasons, including lack of sufficient data to make an assessment of the likelihood a threat will be carried out, lack of information regarding the patient’s medical history and medications (s)he has taken, and lack of sufficient time to adequately assess risks and alternatives

The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain

T o the woman, God said, "I will greatly multiplyyour pain in child bearing; in pain you shallbring forth children, yet your desire shall be for your husband, and he shall rule over you." Genesis 3:16 There is now a well-established body of literature docu-menting the pervasive inadequate treatment of pain in this country. ' There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for their pain. One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. ^ Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do com