Main description:

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.

Contents:

Preface
Acknowledgments
I. Curriculum for Ethics Committees
1. Ethical Foundations of Clinical Practice
The Role of Ethics in Clinical Medicine
Ethics Committees in the Health Care Setting
Fundamental Ethical Principles
Principlism and Alternative Approaches
The Role of Culture, Race, and Ethnicity in Health Care
Conflicting Obligations and Ethical Dilemmas
2. Decision Making and Decisional Capacity in Adults
Health Care Decisions and Decision Making
Decision-Making Capacity
Assessment and Determination of Capacity
Deciding for Patients without Capacity
3. Informed Consent and Refusal
Evolution of the Doctrine of Informed Consent
Elements of Informed Consent and Refusal
The Nature of Informed Consent
Exceptions to the Consent Requirement
4. Truth Telling
Justifications
Disclosure
Disclosure of Adverse Outcomes and Medical Error
Privacy and Confidentiality
Genomic Testing and Control of Information
5. Special Decision-Making Concerns of Minors
Decisional Capacity and Minors
Consent for and by Minors
Confidentiality and Disclosure
Special Problems of Functionally Alone Adolescents
6. Ethical Issues in Reproduction
The Ethics and Politics of Reproductive Choice
Assisted Reproductive Technologies
Surrogacy and Gestational Carriers
Termination of Pregnancy
Maternal-Fetal Issues
Prenatal/Newborn Genetic Testing and Genomic Newborn Screening
Special Decision-Making Concerns of the Elderly
The Other Side of the Mountain
Diminishing Autonomy and Decisional Capacity
"Promise that you won't ever put me in a nursing home"
Independence, Dependence, and Role Reversals
Prior Wishes and Current Needs
Intimacy and Security
Transition from Hospital to Home or Nursing Home
8. Ethical Issues in the Care of Disabled Persons
Disability and Its Place in Bioethics
Defining Disability
The Medical and Social Models of Disability
The Disability Rights Critique of Prenatal Genetic Testing
Special Challenges in the Care of Persons with Severe Cognitive Impairment
Medical Decision Making and the Disabled
9. End-of-Life Issues
Decision Making at the End of Life
Defining Death
Organ Donation
Advance Health Care Planning
Honoring Patients' End-of-Life Decisions
Goals of Care at the End of Life
Forgoing Life-Sustaining Treatment
Protecting Patients from Treatment
Rejection of Recommended Treatment and Requests to "Do Everything"
Medical Futility
10. Palliation
From Caring to Curing and Back Again
The Experience of and Response to Pain
The Moral Imperative to Relieve Pain
Assisted and Permitted Dying
Pediatric Palliative Care
Palliative Care and Hospice
Palliative Care
11. Justice, Health, and Access to Health Care
Access to Health Care in the United States
Justice and Health Disparities
Health Care as a Requirement of Justice
Health Care and Health
Theories of Justice
Rationing
Health Care Reform
12. Organizational Ethics
From Bioethics to Health Care Organizational Ethics
Moral Responsibilities of Health Care Organizations
Organizational Ethics and Compliance
Ethics and the Allocation of Resources
Ethics Committees and Organizational Issues
Developing an Organizational Ethics Service
II. The Creation, Nature, and Functioning of Ethics Committees
13. Profile of Ethics Committees
Origins
Committee Functions
Membership
Expertise in Ethics
Leadership
Securing a Foothold
Clinical Ethics Consultation
Overview of Ethics Consultation
Three Models of Clinical Ethics Consultation Services
Building an Ethics Consultation Service
Credentialing and Privileging Clinical Ethics Consultants
Analytic Approaches to Clinical Ethics Consultation
Selecting the Best Clinical Ethics Consultation Service Model for Your Institution
Access to Clinical Ethics Consultation Policies
15. Ethics Education
Brown Bag Lunches
Journal Clubs
Case Conferences
Ethics Grand Rounds
Ethics Modules in Residency Training and Medical School Programs
Ethics Symposia
White Papers, Memoranda, Guidelines, and Protocols
Additional Education Opportunities
16. Sample Clinical Cases
Adolescent Decision Making
Advance Directives
Autonomy in Tension with Best Interest
Confidentiality
Decisional Capacity
Disclosure and Truth Telling
End-of-Life Care
Forgoing Life-Sustaining Treatment
Goals of Care
Informed Consent and Refusal
Medical Futility
Parental Decision Making
Surrogate Decision Making
17. Sample Policies and Procedures
III. Organizational Codes of Ethics
Regional Medical Center Code of Conduct
Metropolitan Medical Center Code of Ethics
University Health Network Code of Ethics
IV. Key Legal Cases
Informed Consent
Privacy
Confidentiality
Health Care Decision Making
Medical Decision Making for Minors
Reproductive Rights
State Action to Protect Public Health
State Action to Control What Practitioners Must or Must Not Discuss with Their Patients
Health Care Reimbursement
V. An Ethics Committee Meeting
Index