6.4 Ethics Committees
In addition to using established frameworks to resolve ethical dilemmas, nurses can also consult their organization’s ethics committee for ethical guidance in the workplace. Ethics committees are typically composed of interdisciplinary team members such as physicians, nurses, allied health professionals, administrators, social workers, and clergy to problem-solve ethical dilemmas. See Figure 6.13[1] for an illustration of an ethical committee. Hospital ethics committees originally grew out of legal controversies regarding the refusal of life-sustaining treatment, such as the Karen Quinlan case.[2] Read more about the Karen Quinlan case and controversies surrounding life-sustaining treatment in the “Legal Implications” chapter.
After the passage of the Patient Self-Determination Act in 1991, all health care institutions receiving Medicare or Medicaid funding are required to form ethics committees. The Joint Commission (TJC) also requires organizations to have a formalized mechanism of dealing with ethical issues. Nurses should be aware of the process for requesting guidance and support from ethics committees at their workplace for ethical issues affecting patients or staff.[3]
Institutional Review Boards and Ethical Research
Other types of ethics committees have been formed related to medical research on patients. Historically, there are examples of medical research causing harm to patients. For example, an infamous research study called the “Tuskegee Study” raised concern regarding ethical issues in research such as informed consent, paternalism, maleficence, truth-telling, and justice.
In 1932 the Tuskegee Study began a 40-year study regarding the long-term progression of syphilis. Over 600 Black men were told they were receiving free medical care, but researchers only treated men diagnosed with syphilis with aspirin, even after it was discovered that penicillin was a highly effective treatment for the disease. The institute allowed the study to go on, even when men developed long-stage neurological symptoms of the disease and some wives and children became infected with syphilis. In 1972 these consequences of the Tuskegee Study were leaked to the media and public outrage caused the study to shut down.[4]
Potential harm to patients participating in research studies like the Tuskegee Study was rationalized using utilitarianism ethical theory that potential harm to individuals was outweighed by the benefit of new scientific knowledge resulting in greater good for society. As a result of public outrage over ethical concerns related to medical research, Congress recognized that an independent mechanism was needed to protect research subjects. In 1974 regulations were established requiring research with human subjects to undergo review by an institutional review board (IRB) to ensure it meets ethical criteria. The IRB review ensures the following criteria are met:
- The benefits of the research study outweigh the potential risks.
- Individuals’ participation in the research is voluntary.
- Informed consent is obtained from research participants who have the ability to decline participation.
- Participants are aware of the potential risks of participating in the research.[5]
- “Ethics Committee.png” by Meredith Pomietlo for Chippewa Valley Technical College is licensed under CC BY 4.0 ↵
- Annas, G., & Grodin, M. (2016). Hospital ethics committees, consultants, and courts. AMA Journal of Ethics, 18(5), 554-559. https://journalofethics.ama-assn.org/article/hospital-ethics-committees-consultants-and-courts/2016-05 ↵
- Aulisio, M. (2016). Why did hospital ethics committees emerge in the US? AMA Journal of Ethics, 18(5), 546-553. https://journalofethics.ama-assn.org/article/why-did-hospital-ethics-committees-emerge-us/2016-05 ↵
- Centers for Disease Control and Prevention. (2021, April 22). The Tuskegee timeline. https://www.cdc.gov/tuskegee/timeline.htm ↵
- Annas, G., & Grodin, M. (2016). Hospital ethics committees, consultants, and courts. AMA Journal of Ethics, 18(5), 554-559. https://journalofethics.ama-assn.org/article/hospital-ethics-committees-consultants-and-courts/2016-05 ↵
- CrashCourse. (2018, April 18). Henrietta Lacks, the Tuskegee Experiment, and Theical Data Collection: Crash course statistics #12. [Video]. YouTube. All rights reserved. https://youtu.be/CzNANZnoiRs ↵
A formal committee established by a health care organization to problem-solve ethical dilemmas.