Introduction to Next Generation Model of Clinical Ethics

Introduction

Ethics is an organized way to make values-based decisions about:

• actions in particular situations,
• the kind of persons we choose to become,
• what kind of communities we want to have.

The purpose of ethics efforts within a Catholic health care organization is to create Mission focused change leading to improved care for those whom we serve. This can either be done directly or by creating an environment in which the possibility of acting ethically is enhanced, and efforts can be sustained over time (Catholic Health Association Task Group on Organizational Ethics).

Clinical Ethics Committees in Trinity Health

The Past

The clinical ethics committee is a major component within a comprehensive approach to ethics within Trinity Health. The clinical ethics committee is significant because it deals with the ethical delivery of direct patient care, which is core to our mission. In the past, most clinical ethics committees, including those in Trinity Health, understood their scope of service in terms of education, policy review and case consultation/review. It was not uncommon for ethics committees to evaluate their work by tallying the number of educational programs offered or the number of cases reviewed.

Transition to the Next Generation Model of Clinical Ethics

Clinical ethics committees of the past have provided important services to patients, families, clinical providers, those in their organizations and communities. However, due to the defined scope of their work, ethics committees have had limited impact. A transition to the Next Generation Model of Clinical Ethics represents a shift for ethics committees from a primary focus on education, policy review and case consultation/review to system change through quality management.

To be more specific, the Next Generation Model of Clinical Ethics represents a significant transition for clinical ethics committees. The following shifts are key to the transition:

1. The primary function of the clinical ethics committee is no longer case consultation but rather addressing and enhancing processes and structures that affect the ethical delivery of patient care services. Ethics cases will continue to surface and need resolution by clinical ethics committees/case consultation teams. However, in addition to resolving such cases, Next Generation Clinical Ethics Committees will review these cases to identify improvement opportunities that may reduce the repetition of similar ethical dilemmas in the future. In other words, the committee will be moving from a reactive style to one that is Proactive, i.e., anticipating and improving processes to ensure the highest level of ethical health care delivery.
2. Once the organizational structures that contribute to ethical tensions are identified, the committee is responsible for bringing about specific changes that will improve the health and wellbeing of those who receive and provide care. In developing annual goals, Next Generation Clinical Ethics committees are Outcomes Focused, holding themselves accountable for facilitating change in structures and processes that improve the ethical delivery of health care services.
3. Ethics in the organization is not only the responsibility of ethics committee members. Committee members need to work closely with management and others from various departments within the hospital to identify and work toward agreed-upon outcomes. Clinical ethics committees will be more effective as they integrate their efforts with all of the “centers of ethical decision-making” within their health care organization. In other words, the Next Generation Clinical Ethics Committee is Integrated.
4. Catholic Identity, Trinity Health’s Mission, Core Values, Vision and Preferred Cultural Characteristics are significant lenses from which Next Generation Clinical Ethics Committee members analyze processes and structures that affect the ethical delivery of patient care services. In the process of improving processes and structures, the Next Generation Clinical Ethics Committee is Oriented to the Mission and Values of Trinity Health.