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Johns Hopkins University Press
Handbook for Health Care Ethics Committees / Edition 2

Handbook for Health Care Ethics Committees / Edition 2

by Linda Farber Post, Jeffrey Blustein


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Handbook for Health Care Ethics Committees / Edition 2

The Joint Commission (TJC) accredits and certifies more than 19,000 health care organizations in the United States, including hospitals, nursing homes, and home care agencies. Each organization must have a standing health care ethics committee to maintain its status. These interdisciplinary committees are composed of physicians, nurses, attorneys, ethicists, administrators, and interested citizens. Their main function is to review and provide resolutions for specific, individual patient care problems. Many of these committees are well meaning but may lack the information, experience, skills, and formal background in bioethics needed to adequately negotiate the complex ethical issues that arise in clinical and organizational settings.

Handbook for Health Care Ethics Committees was the first book of its kind to address the myriad responsibilities faced by ethics committees, including education, case consultation, and policy development. Adopting an accessible tone and using a case study format, the authors explore serious issues involving informed consent and refusal, decision making and decisional capacity, truth telling, the end of life, palliative care, justice in and access to health care services, and organizational ethics.

The authors have thoroughly updated the content and expanded their focus in the second edition to include ethics committees in other clinical settings, such as long-term care facilities, small community hospitals, rehabilitation centers, and hospices. They have added three new chapters that address reproduction, disability, and the special needs of the elder population, and they provide additional specialized policies and procedures on the book’s website. This guide is an essential resource for all health care ethics committee members.

Product Details

ISBN-13: 9781421416571
Publisher: Johns Hopkins University Press
Publication date: 06/30/2015
Edition description: second edition
Pages: 432
Sales rank: 531,149
Product dimensions: 7.00(w) x 10.00(h) x 1.20(d)
Age Range: 18 Years

About the Author

Linda Farber Post is the director of bioethics at Hackensack University Medical Center and an associate professor at Rutgers New Jersey Medical School and St. Georges University School of Medicine. Jeffrey Blustein is the Arthur Zitrin Professor of Bioethics and a professor of philosophy at the City College of New York.

Table of Contents

Preface xi

Acknowledgments xv

I Curriculum For Ethics Committees 1

1 Ethical Foundations of Clinical Practice 3

The Role of Ethics in Clinical Medicine 4

Ethics Committees in the Health Care Setting 5

Fundamental Ethical Principles 8

Principlism and Alternative Approaches 10

The Role of Culture, Race, and Ethnicity in Health Care 11

Conflicting Obligations and Ethical Dilemmas 12

2 Decision Making and Decisional Capacity in Adults 17

Health Care Decisions and Decision Making 18

Decision-Making Capacity 18

Assessment and Determination of Capacity 22

Deciding for Patients without Capacity 25

3 Informed Consent and Refusal 33

Evolution of the Doctrine of Informed Consent 34

Elements of Informed Consent and Refusal 34

The Nature of Informed Consent 39

Exeptions to the Consent Requirement 42

4 Truth Telling: Disclosure, Privacy, and Confidentiality 46

Justifications 47

Disclosure 48

Disclosure of Adverse Outcomes and Medical Error 53

Privacy and Confidentiality 56

Genomic Testing and Control of Information 62

5 Special Decision-Making Concerns of Minors 67

Decisional Capacity and Minors 67

Consent for and by Minors 72

Confidentiality and Disclosure 81

Special Problems of Functionally Alone Adolescents 83

6 Ethical Issues in Reproduction 88

The Ethics and Politics of Reproductive Choice 88

Assisted Reproductive Technologies 90

Surrogacy and Gestational Carriers 97

Termination of Pregnancy 98

Maternal-Fetal Issues 101

Prenatal/Newborn Genetic Testing and Genomic Newborn Screening 103

7 Special Decision-Making Concerns of the Elderly 107

The Other Side of the Mountain 107

Diminishing Autonomy and Decisional Capacity 108

"Promise that you won't ever put me in a nursing home" 108

Independence, Dependence, and Role Reversals 110

Prior Wishes and Current Needs 113

Intimacy and security 115

Transition from Hospital to Home or Nursing Home 117

8 Ethical Issues in the Care of Disabled Persons 120

Disability and Its Place in Bioethics 120

Defining Disability 121

The Medical and Social Models of Disability 122

The Disability Rights Critique of Prenatal Genetic Testing 123

Special Challenges in the Care of Persons with Severe Cognitive Impairment 125

Medical Decision Making and the Disabled 127

9 End-of-Life Issues 131

Decision Making at the End of Life 132

Defining Death 133

Organ Donation: Donation after Cardiac Death and Elective Ventilation 135

Advance Health Care Planning 137

Honoring Patient's End-of-Life Decisions 147

Goals of Care at the End of life 148

Forgoing Life-Sustaining Treatment 151

Protecting Patients from Treatment 153

Rejection of Recommended Treatment and Requests to "Do Everything" 154

Medical Futility 156

10 Palliation 162

From Caring to Curing and Back Again 162

The Experience of and Response to Pain 164

The Moral Imperative to Relieve Pain 168

Assisted and Permitted Dying 170

Pediatric Palliative Care 174

Palliative Care and Hospice 176

Palliative Care: Giving Up or Giving Permission 179

11 Justice, Health, and Access to Health Care 184

Access to Health Care in the United States 185

Justice and Health Disparities 188

Health Care as a Requirement of Justice 189

Health Care and Health 190

Theories of Justice 191

Rationing 191

Health Care Reform 194

12 Organizational Ethics 197

From Bioethics to Health Care Organizational Ethics 198

Moral Responsibilities of Health Care Organizations 200

Organizational Ethics and Compliance 202

Ethics and the Allocation of Resources 203

Ethics Committees and Organizational Issues 205

Developing an Organizational Ethics Service 206

II The Creation, Nature, and Functioning of Ethics Committees 211

13 Profile of Ethics Committees 213

Origins 213

Committee Functions 214

Membership 215

Expertise in Ethics 217

Leadership 218

Securing a Foothold 219

14 Clinical Ethics Consultation 223

Overview of Ethics Consultation 224

Three Models of Clinical Ethics Consultation Services 225

Building an Ethics Consultation Service: Critical Success Factors 227

Credentialing and Privileging Clinical Ethics Consultants 232

Analytic Approaches to Clinical Ethics Consultation 233

Selecting the Best Clinical Ethics Consultation Service Model for Your Institution 238

Access to Clinical Ethics Consultation Policies 239

15 Ethics Education 242

Brown Bag Lunches 242

Journal Clubs 243

Case Conferences 244

Ethics Grand Rounds 245

Ethics Modules in Residency Training and Medical School Programs 246

Ethics Symposia 247

White Papers, Memoranda, Guidelines, and Protocols 249

Additional Education Opportunities 275

16 Sample Clinical Cases 277

Adolescent Decision Making 277

Advance Directives 279

Autonomy in Tension with Best Interest 283

Confidentiality 286

Decisional Capacity 290

Disclosure and Truth Telling 292

End-of-Life Care 296

Forgoing Life-Sustaining Treatment 299

Goals of Care 301

Informed Consent and Refusal 304

Medical Futility 306

Parental Decision Making 307

Surrogate Decision Making 309

17 Sample Policies and Procedures 313

III Organizational codes of Ethics 339

Regional Medical Center Code of Conduct 340

Metropolitan Medical Center Code of Ethics 342

University Health Network Code of Ethics 345

IV Key Legal Cases 353

Informed Consent 354

Privacy 357

Confidentiality 358

Health Care Decision Making 359

Medical Decision Making for Minors 368

Reproductive Rights 370

State Action to Protect Public Health 376

Their Patients 377

Health Care Reimbursement 379

V An Ethics Committee Meeting 383

Index 403

What People are Saying About This

Kenneth Prager

A practical, readable, and informative guide, Handbook for Health Care Ethics Committees is full of well-chosen cases typical of the ones dealt with by ethics committees, sound scholarship, and analytical, lucid discussions.

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