Why physician assistants should consider joining the hospital ethics committee

THE BENEFITS OF SERVING ON AN ETHICS COMMITTEE

Observing this and other equally challenging quandaries compelled me to explore participation in the ethics committee at my hospital. Ethics committees are frequently designed to help health care providers, patients, and families when ethical concerns arise. While the ethics committee at Seattle's Harborview Medical Center numbers more than 30 members, a core group of approximately 20 interprofessional providers make up the active memberships. Such committees offer opportunities for physician assistant involvement, providing a clear means to provide support and leadership around bioethical issues. Clinicians who have been exposed to cases such as Ms. G.'s may be hungry for ways to engage in the process of maintaining high levels of individual and institutional bioethics decision making while advancing personal knowledge of bioethical principles. Service on an ethics committee can do both. Participating in ethics consults like the one for Ms. G.'s case can provide considerable satisfaction. Having the opportunity to participate in issues of such monumental importance carries great honor and responsibility.

Ethics committees are, by nature, method-driven, and they serve as a guardian of the process. Within that context, outcomes become less of a focus. When all participants trust in the process and in the transparent methods of using sound ethical principles and practices, resolution and result becomes a natural, organic event and not a starting point.

Motivated to action by observation of cases such as this, I explored participation opportunities on the Harborview Medical Center ethics committee during my years there from 2004 to 2008. Owned by King County and operated by the University of Washington, Harborview is the only level 1 trauma center in the state and consequently draws some of the region's most complicated patients. Ethical issues, often involving end-of-life decisions, arise frequently in such settings and offer ample opportunity to apply bioethical principles in treating these complex patients.

Many ethics committees also coordinate educational forums and conduct case-based ethics consultations in the hospital for patients, families, and staff. This includes taking ethics call, where the committee members rotate through month long shifts.

For any hospital-based PA interested in bioethics and thinking of serving on the hospital ethics committee, here are some suggested steps:

• Find out when the ethics committee meets.

• Ask if you can observe, and introduce yourself to the members (this may seem like a self-evident step but is often overlooked).

• Be present and participate in as many ways as possible in meetings or forums.

• Make your interest known to committee members. Most committees pride themselves on including members from many professions. If there is not a PA already on the committee, this may make you even more attractive.

Service on an ethics committee can provide numerous benefits to PAs interested in bioethical issues. As a companion to more formal study, committee service offers a fertile environment for learning and applying bioethical principles. Additionally, such service invites collaboration with numerous other professionals, allowing PAs to learn from collegial interaction with clinicians experienced in applying bioethical issues while giving these colleagues a chance to observe and work with a PA. As we know, many in the health care professions still know little about PA practice, education, and history. Consequently, PA utilization continues to be a challenge in all settings. Exposing other health professions to the still-emerging roles of PAs while working collaboratively on compelling bioethical issues can create good will while potentially enriching institutional views of our profession. This is, of course, in addition to the primary goal of ethics work and of all PA endeavors, which is to maximize the respectful care of patients. JAAPA

Jim Anderson is the PA-NP Supervisor, Department of Orthopedics, Seattle Children's Hospital, Seattle, Washington, and a member of the JAAPA editorial board. He has indicated no relationships to disclose relating to the content of this article.

Annotated bibliography

• Jonsen AR, Siegler M, Winslade WJ. Contextual features. In: Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 6th ed. New York, NY: McGraw Hill; 2006:163-164.

This classic text is often used as a source in case analysis. The text has evolved with the rapid changes in science and their application in medical therapy. This edition includes classic cases and new cases illustrating the use of the “four topic method.” It emphasizes the importance of the consistent collection of all data and how to approach data analysis in a contextual manner.

• Beauchamp T, Childress JF. Principles and Practices of Biomedical Ethics. 6th ed. New York, NY: Oxford University Press; 2009.

This text is often used by members of ethics committees to provide a common language in the discussion of ethical dilemmas. As Jonsen stated, “This book is the thesaurus of bioethical discourse.”

• Hester DM. Ethics by Committee. New York, NY: Rowman & Littlefield Publishers, Inc; 2008.

A great resource for PAs joining ethics committees, this book discusses tensions within ethics committees and the need for continuing education. It addresses the religious, cultural, and socioeconomics aspects of committee membership and emphasizes that patients are the focus of the consultation and medical decisions.

• Klugman CM, Dalinis PM. Ethical Issues in Rural Health Care. Baltimore, Md: The Johns Hopkins University Press; 2008.

Ethics issues in rural America have their own challenges, and this text discusses some of them. Chapter titles include “Rural-Urban Differences in End-of Life-Care: Reflections on Social Contracts” and “Supporting the Rural Physician: Processes and Programs.”

• Aulisio MR, Moore J, Blanchard M, et al. Clinical ethics consultation ethics integration in an urban public hospital. Cambridge Quarterly of Healthcare Ethics. 2009;18(4):371-383.

The authors discuss the evolution of the ethics committee and consultation in a major metropolitan public hospital. The mission for the public hospital, unreimbursed care, and equal access to equal care are addressed, as is how the ethics committee goal of supporting the individual patient and the mission of the institution can conflict.

• Jackson EW, Olive KE. Ethics committees in small, rural hospitals in East Tennessee. Southern Medical Journal. 2009;102(5):481-485.

Jackson provides an original study to identify the structure and function of the ethics committees within East Tennessee. A key point is that the small size of the hospitals and reduced bureaucracy make for fewer consults.