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The primary objective of The Health Care Ethics Con sultant is to focus attention on an immediate Contemporary Issues in Biomedicine, Ethics, and Society.
Table of contents
- AMA Journal of Ethics
- The Health Care Ethics Consultant (Contemporary Issues in Biomedicine, Ethics, | eBay
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- Illuminating the Art of Medicine
Who should be considered health care ethics consultants? Whom should they advise? What should be their responsi bilities and what kind of training should they have? Should there be some kind of accreditation or certification program to ensure that those who call themselves ethics consultants are in fact qualified to advise, consult, research, and write in health care ethics?
The distinguished authors ofthese articles are persons with diverse backgrounds, interests, presumptions, and val ues. Not surprisingly, therefore, diverse responses have emerged to the questions posed. The goals of HCEC were proposed by the task force. As pointed out by the task force, we noted that whether a consensus regarding the goal of medical care was achieved is a critical outcome measurement for evaluating the effectiveness of HCEC.
Therefore, whether a consensus regarding the goal of medical care was achieved was examined and compared between the HCEC group and UC group in this study. The results of our study agree with those of several previous studies showing, for example, that HCEC is associated with short lengths of entire ICU stay and entire hospital stay [ 11 , 12 ].
However, the entire ICU stay and hospital stay in our study were considerably longer than those reported by Schneiderman et al.
Therefore, we examined the outcomes of HCEC by using the length of ICU stay and hospital stay after the occurrence of medical uncertainty or conflict regarding value-laden issues, which more directly measured the influence of HCEC than the length of entire ICU stay and entire hospital stay. Our ethics consultants were encouraged to conduct HCEC following the ethics facilitation approach as proposed by Aulisio et al.
However, the ethics facilitation approach to conduct HCEC in the medical encounters in Taiwan might be of concern because individual autonomy may not be the main societal value. For several thousand years, Confucian philosophy has deeply influenced societal values, and ethical considerations in East Asian countries such as Taiwan [ 24 ]. Although the ongoing westernization of East Asian biomedical ethics in Taiwan is convincing, family autonomy seems to remain as the main societal value [ 21 ].
There were only few formal and informal HCEC services conducted by two individual ethics consultants who had several years of clinical ethics training as well as medical training. Our findings demonstrated that HCEC reduced the consumption of medical resources as indicated by shorter entire ICU stay, entire hospital stay, and shorter ICU and hospital stay after the occurrence of the medical uncertainty or conflict regarding value-laden issues. YC carried out the literature review, study design, statistical analysis and drafted the manuscript. TC carried out the statistical analysis, edited the draft and tables.
YK helped with the literature review and statistical analysis. PT helped with study design and data collection. TH helped with drafting the manuscript and coordination. WK participated in the study design.
AMA Journal of Ethics
All authors read and approved the final manuscript. National Center for Biotechnology Information , U. Published online Jan 3. Received Aug 16; Accepted Dec This is an open access article distributed under the terms of the Creative Commons Attribution License http: This article has been cited by other articles in PMC.
Methods Patients with medical uncertainty or conflict regarding value-laden issues, and requests made by the attending physicians or nurses for HCEC from December 1, to April 30, were randomly assigned to the usual care group UC group and the intervention group HCEC group. Results Thirty-three patients Conclusions Our findings demonstrated that HCEC were associated with reduced consumption of medical resources as indicated by shorter entire ICU stay, entire hospital stay, and shorter ICU and hospital stay after the occurrence of the medical uncertainty or conflict regarding value-laden issues.
Health care ethics consultation, Effectiveness, Randomization, Intention-to-treat. Background Health care ethics consultation HCEC has been applied to clinical practice for several decades. Methods Study design This study was conducted in three surgical intensive care units in National Taiwan University Hospital.
Data collection Data was concurrently and retrospectively collected from the review of medical records and HCEC records.
The Health Care Ethics Consultant (Contemporary Issues in Biomedicine, Ethics, | eBay
Intention-to-treat principle Data analysis was based on the intention-to-treat principle, implying that the comparison of variables is based on the initial treatment assignment and not on the treatment eventually received. Statistical analysis Our analysis examined univariate characteristics central tendency, dispersion, and distribution and bivariate relationships correlations.
Results During data collection period, a total of 62 patients with the medical uncertainty or conflict regarding value-laden issues and requests for HCEC service were collected. Table 1 Issues which health care workers sought assistance with during data collection period. Open in a separate window. HCEC , health care ethics consultation.
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Discussion Main findings Examining the effectiveness of HCEC demonstrated that HCEC was associated with achieving a consensus regarding the goal of medical care, shorter length of entire ICU and hospital stay, and shorter length of ICU and hospital stay after patients encountering medical uncertainty or conflict regarding value-laden issues.
Ethical issues for requesting health care ethics consultation Several studies have reported the ethical issues which the patient or health care team members encountered for requesting HCEC. Empowerment for requesting health care ethics consultation According to Johnson et al. Appropriateness of outcome measurements Numerous empirical studies have been initiated because of concerns related to accountability and quality assurance in HCEC.
Cultural differences in conducting health care ethics consultation Our ethics consultants were encouraged to conduct HCEC following the ethics facilitation approach as proposed by Aulisio et al. Competing interests The authors declare that they have no competing interests. Pre-publication history The pre-publication history for this paper can be accessed here: The American Society of Bioethics and Humanities; A national survey of hospital ethics committees.
A national study of ethics committees. Ethics consultations in united states hospitals: Use of the medical ethics consultation service in a busy level I trauma center: Some suggestions for holding bioethics committees and consultants accountable. Camb Q Healthc Ethics.
Quality assessment of ethics in health care: Am J Law Med. Concepts in evaluation applied to ethics consultation research. Evaluating outcomes in ethics consultation research. The current preoccupation of the culture of medicine with measurability, understood in quantitative performance measures, will require HCECs to be disciplined and creative in demonstrating to institutional leaders the value of the mediating activity HCECs perform.
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This demonstration must be more than is required for the formalities of JCAHO approval and eventually should be based on empirical data. One potential area that HCECs could develop is increasing patient and family access to the ethics committee, especially consultation services, as a way of improving patient satisfaction. HCECs will need moral courage and discernment to reconcile core ethical principles and professional standards of medical culture at its best with increasing pressures in society toward commercialization and utility.
Strangers at the Bedside: The role and legal status of health care ethics committees in the United States. Legal Perspectives in Bioethics. Ethics committees and ethics consultations. Macmillan Reference USA; Responding to Ethics Questions in Health Care.
Illuminating the Art of Medicine
US Department of Veterans Affairs; Accessed March 28, Attorneys on bioethics committees: Updated October 22, Accessed March 23, Joint Commission for Accreditation of Healthcare Organizations. Joint Commission for Accreditation of Healthcare Organizations; Threats to Impartiality and Independence One function of HCECs is to uphold established legal, professional, and ethical principles and standards.
The Birth of Bioethics. Oxford University Press; What is an Emergency Ethics Consultation?