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"Community Voices and Views in Clinical Bioethics Policies: Piloting an Innovative Approach to Broadening Community Representation"
Each hospital must have some kind of ethics service – a mechanism in place to address difficult ethical decisions and disagreements in health care as required by the Joint Commission on the Accreditation of Hospitals. Typically, hospital ethics committees are comprised of medical physicians, nurses, social workers, and other hospital staff, sometimes including a community member who provides an “outside” voice. As a result, hospital ethics committees can sometimes lack broad representation from the diverse communities they serve, and the cultural, religious, and moral values of local community members may not be adequately or comprehensively represented. As national health care policy discussions unfold and intensify, the need for inclusive ethics policies becomes increasingly relevant. In Boston, Harvard Medical School’s Division of Medical Ethics is piloting an innovative approach to broadening community representation and bridging the communications gap between health care practitioners and communities: a Community Ethics Committee (CEC). This group, comprised completely of community members not employed by health care facilities, has been active for three years and is diverse in terms of religious affiliation, age, socioeconomic status, cultural and language groups, and educational backgrounds. When the ethics committee at a hospital wants a community perspective and input on an issue, particularly in the development of policy, a request is made for the CEC to review and comment. Issues that the CEC has addressed include pediatric organ donation using cardiac death criteria, non-therapeutic CPR, staff interactions with patients via social internet media, and palliative sedation. The CEC works with a wide array of local communities to gather opinions and perspectives on a given issue for the purpose of providing policy recommendations. The team augments their outreach with several customized social media technologies, including blogs and Twitter. As part of its mission and as an adjunct to formal policy recommendations to ethics committees at participating hospitals, the CEC plans to conduct educational outreach to local communities, expanding the dialogue which the committee members began in its policy review. Additionally, several CEC members now serve as community representatives on hospital ethics committees, increasing their exposure to the issues addressed by these groups. We describe the current CEC model and recommend that CECs be replicated throughout the country to enable improved representation and facilitate meaningful communication between practitioners and communities. Ultimately, we envision a network of CECs that would share findings at the regional and national levels.
Primary Contributor: Lori Bruce , M.A. (Presenting) ;
Co-Contributors: Carol L Powers, J.D. , HMS Community Ethics Committee, and Christine Mitchell , RN, MS, MTS , Harvard Medical School