Hospital ethics boards are the local face of struggle for moral decision-making amid medical change. In hospitals large and small, ethics committees weigh grave questions about medical treatment. Most meetings are quiet and businesslike, dealing with hospital policy or board member education. Yet frequently, these committees are asked by patients, families, nurses or doctors to recommend action – or inaction – on difficult ethical questions involving the collision of new technology, religious beliefs, high costs and consumer demand. Which patient should have an organ transplant? Who will be taken off life support? Should someone near death be resuscitated? How aggressively should new technologies be employed?

Ethics committees arose in the early 1970s as physicians, administrators and lay people wrestled with how to ethically use technology. Catholic hospitals were among the first to form them. Members are all appointed by the hospital and are usually hospital administration or medical staff. A member of the public and a chaplain also may be included. In response to increasingly complex decisions, many hospitals are adding experts in bioethics and offering more sophisticated training to help members make informed ethical decisions. While religion may play a stronger part in religious hospitals, the religious beliefs of families, doctors, nurses and administrators can be a factor in any patient’s treatment.

Why it Matters
The toughest medical decisions concern when life begins, when it should end and how much money and effort should be spent to sustain or improve it. These decisions strike at core beliefs about the nature of life and death, beliefs that are often shaped by religion.

Story angles
• Has membership of area hospital ethics committees and the cases they consider changed over time? Who serves, and how are members chosen? Is training offered?
• What role, if any, does religion play in a committee’s deliberations? Do hospital chaplains or clergy have a role in the committee? Do they speak solely for their religious tradition or consider others? Are there differences in ethics committee membership and decisions between secular hospitals and hospitals owned by religious institutions and others?
• Ask committee members what are the most difficult medical ethics issues on the horizon in your locale. Draw out specifics and examples.
• Ask to see an ethics committee’s charter, usually a hospital policy, which outlines the minimum membership, roles and basics of operation. When was it established, and has it changed in response to changes in medical treatment? A reporter can reasonably expect a hospital committee member to discuss deliberations that don’t include personally identifiable health information about patients. Professionals can be quite forthcoming with clinical examples without compromising confidentiality, says Tom Mayo, director of the Cary M. Maguire Center for Ethics and Public Responsibility at Southern Methodist University in Dallas.

National sources

• Tom Mayo is director of the Cary M. Maguire Center for Ethics and Public Responsibility at Southern Methodist University in Dallas. He teaches ethics to medical and law students, serves on five hospital ethics boards and is a fellow of the American Health Lawyers Association. He has expertise in ethical questions involving Medicare fraud and abuse, organ transplantation, tax-exempt status of health care organizations and, particularly, end-of-life decision-making and advance directives. He says most committee decisions involve end-of-life care. His web page offers links for finding bioethics resources. Contact 214-768-3767, tmayo@mail.smu.edu.
• Dr. Michael Moshe Akerman is associate professor of medicine at the State University of New York Health Science Center at Brooklyn. He is president of the National Association of Judaism and Medicine. He can address how Judaism informs the work of ethics committees, particularly in Jewish hospitals. Contact 917-760-2770.
• Arthur Caplan is Emmanuel and Robert Hart Professor of Bioethics at the University of Pennsylvania Center for Bioethics. He co-edited Who Owns Life? (Prometheus Books, 2002), Assisted Suicide: Finding Common Ground (Indiana University Press, 2002) and The Ethics of Organ Transplants: The Current Debate (Prometheus Books, 1999). Contact 215-898-7136, caplan@mail.med.upenn.edu.
• Carl Middleton is vice president for ethics and theology at the Denver-based Catholic Health Initiatives. Middleton is a naturopath with a doctor of divinity degree. CHI is operated by a religious-lay partnership. It is the second-largest Catholic health systems firm in the country, with 69 hospitals; 43 long-term care, assisted and independent living and residential facilities; and five community-based health organizations in 19 states. Contact 303-298-9100.
• The American Society of Law, Medicine and Ethics, based in Boston, aims to be a forum for debate, scholarship and critical thought among professionals who work at the intersection of law, health care and ethics. Contact director Benjamin Moulton, attorney and health care law expert who teaches in the Department of Health Policy and Management at the Harvard School of Public Health. Contact 617-262-4990, bmoulton@aslme.org.
• Sister Carol Taylor is director of the Center for Clinical Bioethics at Georgetown University. She also is a senior research scholar at the Kennedy Institute of Ethics and an assistant professor of nursing at Georgetown. Her background is in philosophy, bioethics and nursing. She is experienced in caring for chronically and critically ill patients and their families. She is an ethics consultant to health care systems and professional organizations. Scholars at the Center for Clinical Bioethics, which offers courses in organizational ethics, participate in internal review boards, the Georgetown University Hospital Ethics Committee and take part in interdisciplinary and post-care rounds. Contact 202-687-4783, taylorcr@georgetown.edu.
• Gilbert Meilaender is a member of the President’s Council on Bioethics and the chairman in Christian ethics at Valparaiso University in Valparaiso, Ind. He is the author of Bioethics: A Primer for Christians (Eerdmans Publishing Co., 2004). Contact 202-296-4669, gilbert.meilaender@valpo.edu.
• Abdulaziz A. Sachedina is a coordinator of the Islamic bioethics group of the International Association of Bioethics and is a professor of Islamic and Shi’ite studies at the University of Virginia in Charlottesville. He wrote the article “Human Clones: An Islamic View” for the book The Human Cloning Debate (Berkeley Hills Books, 2002). He also contributed the entry “Bioethics” for The Oxford Dictionary of Islam (Oxford University Press, 2002). Contact 434-924-6725, Sachedina@virginia.edu.
• Ann Cook is director of the National Rural Bioethics Project, based at the University of Montana in Missoula, where she is an associate professor of psychology. The project helps address ethics issues in rural communities. Contact 406-243-2467, ann.cook@mso.umt.edu.
• The National Ethics Committee is authorized by the Office of the Under Secretary for Health of the Veterans Health Administration. It is not a hospital advisory committee in the traditional sense but is an interdisciplinary group from around the nation, charged to issue reports on ethics-related topics, ranging from resource allocation to impaired-consent capacity. It is part of the National Center for Ethics in Health Care and analyzes ethical issues affecting the health and care of veterans. Contact the chaplain, Michael McCoy, associate director of the National Chaplain Center, 757-728-3180, Michael.McCoy@med.va.gov.

Background

HISTORY
• The first call for ethics committees was in 1971, when the Catholic Hospital Association of Canada and the Canadian Catholic bishops, in their Ethical and Religious Directives for Catholic Hospitals, recommended that Catholic institutions educate the hospital community on moral dimensions of life-sustaining technologies, establish a forum for dialogue about using technology and make ethics policy, according to writings by Elizabeth Heitman, associate professor at the Vanderbilt University Medical Center’s Center for Clinical and Research Ethics.
• There are two types of ethics committees: administrative or medical staff. They usually have three tasks: to educate administrators and the hospital community; to consult as requested on medical cases (no one is required to take the committees’ advice); and to set and review hospital policy. In ethics consulting, cases most often entail issues about the end of life, genetics testing and the appropriate use of technology.
• A committee’s services and ambitions vary widely, depending on resources and a hospital’s sophistication. Not all meet regularly; some convene just a couple times yearly or as required. In religious hospitals, ethics committees may or may not take religion into account, depending on the hospital.

ETHICS STANDARDS
Medical ethics is a young field, and there are no regulation or uniform standards for ethics committees. Here are some resources:
• The American Society for Bioethics and Humanities, a 1,500-member society that fosters idea exchange and discussion among professionals, has a list of minimum competencies (called “Core Competencies for Health Care Ethics Consultation“) for bioethics consultants. It is frequently used by committees to help guide their composition and education. It also lists academic programs around the country.
• The American Medical Association has brief, broad guidelines for ethics committees. The AMA also offers guidelines for patients and physicians who want to invoke an ethics consultation. Committee training takes the form of self-education or seminars. Legal and medical students study ethics committees in texts and classes. No journal or organization follows the world of ethics committees.Ethics boards are studied by American scholars, but perhaps not as widely as in Canada, Britain and Australia, with their centralized health care planning. Search the PubMed Central journal archive for article citations leading to authors and experts.
• Tom Mayo’s web page offers links, by subcategory, of bioethics resources on the web. Mayo is director of the Cary M. Maguire Center for Ethics and Public Responsibility at Southern Methodist University in Dallas.

ARTICLES
• Read a July 4, 2005, New York Times story about a Bronx medical center’s program in which doctors and ethicists work to resolve issues with patients. It’s posted by the Anabaptist Center for Healthcare Ethics.
• Read an Aug. 2, 2001, New York Times story about bioethicists’ increasingly controversial role in public debates. It’s posted by the Forensic Psychiatry & Medicine web page of Dr. Harold J. Bursztajn.
Read “Ethics committees in religious hospitals: A different landscape” and “Does religious affiliation matter?: Religion and ethics committees” in the August 2001 Bulletin of the Park Ridge Center for Health, Faith and Ethics.

Regional sources

STATE BY STATE
• To find a medical ethicist near you, check the American Society for Bioethics and Humanities’ membership directory tool. Query members about their experience with hospital ethics boards. Use the organization’s list of affinity groups to find experts in particular fields.
• University-based schools of public health employ ethicists and teach courses on medical ethics. See a listing of public health schools by the American Public Health Association for a school in your area.
• Find experts on “bioethics and the church” in a state-by-state listing provided by the Center for Bioethics and Human Dignity, which has a Christian perspective.

IN THE NORTHEAST
• Lynn Pasquerella, a philosophy professor, is the interim vice provost for graduate studies, research and outreach at the University of Rhode Island. She has chaired the university’s institutional review board and currently is chairwoman of the institutional review board at Day Kimball Hospital in Putnam, Conn., where she has also served on the ethics board since 1989. Contact 401-874-2223, Paska@uri.edu.
• Dr. Alexandra Flather-Morgan Cist, board-certified in internal medicine, pulmonary medicine and critical care medicine, is on staff at Massachusetts General Hospital, where she serves on the ethics task force and other ethics committees. Contact 617-726-2707.
• Sister Elizabeth Oleksak, a member of the order of the Sisters of Providence, has chaired the ethics committee at Farren Care Center in Turners Falls, Mass. She was a health care administrator for 26 years until her 2002 retirement. She can talk about the relationship between her order and the committee in ethics deliberations. Contact her though Farren Care Center, 413-774-3111.

IN THE EAST
• Dr. Robert M. Arnold is a professor of medicine and the Leo H. Criep Chair in Patient Care as well as chief of the section of palliative care and medical ethics at the University of Pittsburgh School of Medicine’s Institute for Doctor-Patient Communication. http://www.dgim.pitt.edu/idpc/ Arnold teaches physician leaders how to educate peers to better communicate regarding ethical, psychosocial and existential issues at the end of life. Contact 412-692-4834, rabob@pitt.edu.
• Maryland Assistant Attorney General Jack Schwartz directs health policy development for the state attorney general’s office. He has advised numerous hospital ethics boards. Contact 410-576-6327, jschwartz@oag.state.md.us.
• The Maryland Healthcare Ethics Committee Network, established by the Law and Health Care Program at the University of Maryland School of Law, serves as a resource for ethics committees.
• Dr. Michael A. Williams is associate professor of neurology and neurosurgery at Johns Hopkins University, where he teaches at the Bioethics Institute and at the School of Nursing. He is co-chairman of the Johns Hopkins Hospital Ethics Committee. His interest areas include end-of-life care and the ethical issues of organ donation, of intracranial pressure and of hydrocephalus. Contact 410-955-7482, michael.a.williams@jhmi.edu.
• Dr. John Collins Harvey, a physician with a doctorate in theology, is senior research scholar and professor emeritus of medicine of the Georgetown University Center for Clinical Bioethics in Washington, D.C. His bioethics interests include withdrawal of treatment, advance directives, euthanasia and physician-assisted suicide. Contact 202-687-1160, harveyjc@georgetown.edu.
• Anne Griswold Peirce is associate dean for academic affairs and an associate professor at Columbia University School of Nursing in New York, N.Y. She published the paper “Some Considerations about Decisions and Decision-Makers in Hospital Ethics Committees” in the Oct. 14, 2004, issue of the Online Journal of Health Ethics. Contact 212-305-3459, agp1@columbia.edu.

IN THE SOUTHEAST
• Ruth Gaare Bernheim, an attorney and public health expert, is associate director of the University of Virginia Institute for Practical Ethics and Public Life and a core faculty member of the medical school’s Center for Biomedical Ethics. She has served as an adviser to numerous hospital ethics boards and has taught a course on ethical issues in the evolving care delivery system. Contact 434-924-3487, rg3r@virginia.edu.
• Dr. Carlos Gomez is associate director of the Capital Hospice’s nonprofit Institute for Education and Leadership in Fairfax, Va. Gomez appeared in the 2000 PBS series On Our Own Terms: Moyers on Dying. He can talk about how ethics committees are involved in hospice care. Contact 703-383-9222.
• Kenneth R. White is associate professor of health administration at Virginia Commonwealth University’s School of Allied Health Professions in Richmond. He is a registered nurse with clinical and administrative experience and has also worked in hospital operations and marketing. He has written about end-of-life care, charity care, HIV care and the administrative concerns unique to Roman Catholic hospitals. Contact 804-828-8651, krwhite@vcu.edu.
• Philip A.D. Schneider, associate professor of philosophy at Coastal Carolina University, wrote a paper on his study of 12 hospital ethics committees in eastern South Carolina. Contact pschneid@coastal.edu.
• Christine E. Gudorf, professor of religious studies at Florida International University in Miami, has written about the issues of integrating ethics into hospital care. Contact 305-348-2729, gudorf@fiu.edu.

IN THE SOUTH
• Elizabeth Heitman is associate professor at Vanderbilt University Medical Center’s Center for Clinical and Research Ethics in Nashville. She has written about the history of institutional ethics committees. Contact 615-936-2686 ext. 4, elizabeth.heitman@vanderbilt.edu.
• Camille Barsukiewicz is an assistant professor in the University of Memphis’ master of health administration degree program, where she teaches health care regulation, law and ethics. She co-wrote the fifth edition of The U.S. Health System: Origins and Functions (Thomson Delmar Learning, 2002). Contact 901-678-5057, cbrskwcz@memphis.edu.

IN THE MIDWEST
• Dr. Ruth M. Farrell is a Cleveland physician with a background in bioethics and philosophy. She is particularly interested in assisted reproductive technologies and new treatments for infertility patients. Farrell serves on numerous hospital quality assurance and ethics committees. She founded and coordinates the obstetrics and gynecology residents’ ethics curriculum at the University Hospital of Cleveland, and she’s a member of the Case Western Reserve University School of Medicine’s bioethics department advisory board. Contact rfarrell@jhsph.edu.
• Psychology professor Richard L. Wiener leads a research team at the University of Nebraska-Lincoln that studies the impact of law on everyday behavior, the implementation of law in the legal system, and the fit between the law and assumptions about human conduct. The team has studied hospital ethics boards’ end-of-life recommendations. Contact 402-472-1137, rwiener2@unl.edu.
• David Orentlicher, a physician, is Samuel R. Rosen Professor of Law and co-director of the William S. and Christine S. Hall Center for Law and Health at Indiana University’s School of Law in Indianapolis. He is an expert in bioethics, health law, health-care planning and abortion and formerly was director of the American Medical Association’s Division of Medical Ethics. He is also an Indiana state representative. Contact 317-274-4993, dorentli@iupui.edu.
• Sara Taub is a senior research assistant at the American Medical Association’s Council on Ethical and Judicial Affairs in Chicago. She assists the council by researching ethics topics of medical interest and developing policy, responds to inquiries concerning AMA ethics policy and has served on several hospital ethics committees. Contact 800-621-8335.
• The Ohio Healthcare Ethics Committees Information Project has surveyed hospital ethics committees throughout the state twice. Contact the Cleveland State University faculty working on the project through their Web site or at 216-687-9255.
• Sandy Larson is the chaplain of MeritCare Health System, based in Fargo, N.D. Contact 701-234-6000.
• Stephen Streed is director of chaplaincy and chairman of the ethics committee at the Eventide Lutheran home for the elderly in Moorhead, Minn. He can talk about the composition of the ethics committee at the home and about issues facing ethics committees in geriatric situations. Contact 218-233-7508.
• E. David Cook is the Holmes Professor of Faith and Learning in the Department of Philosophy at Wheaton College in Illinois. His scholarship focuses on the medical ethical issues at the beginning and end of life, genetics, resource allocation, gerontology, research ethics, consent and confidentiality. He is also a fellow and chaplain of Green College, University of Oxford and a professor of Christian Ethics at Southern Seminary. Contact 630-752-5040, David.Cook@wheaton.edu.
• Paige Cunningham is an attorney and educator who is a member of the board of directors of Americans United for Life, a senior fellow of The Center for Bioethics and Human Dignity and a fellow with the Wilberforce Forum’s Council for Biotechnology Policy. Contact through the center’s public relations director, Sarah J. Flashing, 847-317-4097, sflashing@cbhd.org.
• Barbara A. Mulich serves on the staff of the Center for Health Ethics and Law at West Virginia University in Morgantown. She serves as a member of West Virginia University Hospitals Ethics Committee and coordinates the Morgantown Regional Palliative Care Committee. Contact through the center, 877-209-8086.
• Joal Hill is senior ethics consultant and director of research ethics at the Park Ridge Center for Health, Faith and Ethics in Chicago. Contact 847-384-3507.

IN THE SOUTHWEST
• Dawn H. Seery is bioethics consultant and chair of the Bioethics Committee for the multi-hospital Methodist Healthcare System of San Antonio, Texas. Dawn has been involved in hospital ethics committees for more than 20 years. Her background includes critical care and palliative care education and management. Her graduate degree is in bioethics and health policy. She provides rural and small community outreach for hospital ethics committee development and continuing education and is the program coordinator for Texas Bioethics Resource Consortium. Contact 210-575-4154, dawn.seery@mhshealth.com.
• David Isch, director of ethics at Harris Methodist Fort Worth hospital, has a background in religion and philosophy and has 17 years’ experience in clinical health care. He also teaches philosophy and ethics to undergraduate and medical school students and has received specialty training in human research ethics and biomedical ethics and business ethics. Contact 817-882-2155, DavidIsch@texashealth.org.
• Stanley Joel Reiser co-directs the biomedical ethics program and is an adjunct faculty member in religious studies at Rice University in Houston. He co-edited Integrity in Health Care Institutions: Humane Environments for Teaching, Inquiry and Healing (University of Iowa Press, 1990) and wrote the chapter “Hospitals as Humane Corporations.” His current research is on the intersection of medicine and public health, including experimental therapies. Contact 713-500-5080, sreiser@heart.med.uth.tmc.edu.
• Baruch A. Brody is the Leon Jaworski Professor of Biomedical Ethics and director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston. Contact 713-798-3503, bbrody@bcm.tmc.edu.
• Munawar A. Anees is executive director of Knowledge Management Systems (KnowSys) in Tucson, Ariz., and a biologist who has written extensively on religion and science, bioethics and Islamic studies, including Islam and Biological Futures: Ethics, Gender and Technology (Mansell, 1990). He sees a growing concern among scientists of the moral consequences of their work and says that can become the basis for “a balancing act” between science and religion. Contact 602-532-7148.

IN THE WEST/NORTHWEST
• Nancy Scheper-Hughes is project director of Organs Watch, a human rights documentation center that tracks the ethical and legal uses and sources of transplant organs globally. Scheper-Hughes is a professor of medical anthropology at the University of California, Berkeley, where she directs the doctoral program in Critical Studies in Medicine, Science and the Body. Contact 510-642-8431 or 510-642-3391, nsh@sscl.berkeley.edu.
• Margaret McLean is a senior lecturer in the religious studies department at Santa Clara University in California and assistant director of the Markkula Center for Applied Ethics. Her background is in life sciences and divinity; she has a doctorate in ethics from the Graduate Theological Union in Berkeley. She teaches Christian ethics, religion and science, and medical ethics. Contact 408-554-5319, mmclean@scu.edu.
• Meghan Conroy leads national sales for Secara, a clinical line of Chinese herbal medicines. She has a background in biological sciences and has worked for Johnson & Johnson and Abbott Laboratories and been a volunteer on three hospital ethics boards, most recently at Stanford Medical Center. Contact 888-732-2721.
• Jan C. Heller is system director of the Office of Ethics and Theology for Providence Health System, which has 50 facilities in Alaska, Washington, Oregon and California. An Episcopal priest, he has a doctorate in ethics in addition to a master of divinity degree. Contact him in Seattle at 206-464-3036, jan.heller@providence.org.
• Barbara A. Koenig is an anthropologist who studies contemporary biomedicine and bioethics at Stanford Center for Biomedical Ethics at Stanford University in Palo Alto, Calif. She is also co-director of the university’s Program in Genomics, Ethics and Society. Contact 650-725-6103, bkoenig@stanford.edu.
• Patrick McCormick is an associate professor of Christian ethics at Gonzaga University, in Spokane, Wash. He is author of Sin as Addiction (Paulist Press, 1989) and Character, Choices & Community: The Three Faces of Christian Ethics (Paulist Press, 1998). He is a columnist for U.S. Catholic magazine. He has served as a consultant on various hospital ethics boards. Ask him about how Catholic guidance affects decision making in hospital ethics committees. Contact 509-323-6715, mccormick@gonzaga.edu.