Edward M. Spencer

Quality control for hospitals' clinical ethics services: proposed standards.

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a Presidents Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states stipulate that certain types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee.

Evidence-based medecine: Why clinical ethicists should be concerned

Evidence-based medicine purports to be the integration of three prongs; best research evidence, clinical expertise, and patient values and preferences. Controversy still surrounds the application of evidence-based medicine and undoubtedly controversy will persist in the treatment of specific diseases, thus allowing for some flexibility in decision-making. Yet, the idea that variation is expensive has gained wide acceptance and variation can best be controlled through rigid systems. So given the financial constraints facing healthcare organizations, as well as pressure from such august organizations like the Institute of Medicine to implement evidence-based medicine, flexibility in decision-making may ultimately become the exception rather than the rule. Certainly, in the short-term, the advantages of a rigid system, notably its cost advantage, overwhelm the advantages of a more naturally adaptive system--and so where possible evidence-based medicine will probably be implemented within a rigid context. Rigidity in system design will affect the activities of clinical ethics. To be effective in such a system, clinical ethicists will need an understanding of the system within which they practice including its values, goals, operations, and tools. This is a knowledge area which few in this field currently have and which they may not wish to acquire. But, if clinical ethicists expect to have credibility in responding to these changes, they must understand the values, goals, processes and outcomes of the system in place and be able to advocate for greater flexibility and greater attention to patient values and preferences even within a rigid mechanical system.

Virginia Bioethics Network.

The Virginia Bioethics Network (VBN), a self-governing, self-supporting organization of Virginia healthcare institutions and other interested groups and individuals, was officially incorporated in the state of Virginia in December 1993.... The mission of the VBN is to advance the knowledge of biomedical ethics within Virginia healthcare institutions and their communities and to support the development of local institutional ethics programs and regional ethics networks throughout the state. The ultimate goal is enhancement of ethical decision making in the clinical setting with all pertinent factors, including community values, being given due consideration during the decision-making process....