Facilitating Medical Ethics Case Review: What Ethics Committees Can Learn from Mediation and Facilitation Techniques

Abstract

Medical ethics committees are increasingly called on to assist doctors, patients, and families in resolving difficult ethics issues. Although committees are becoming more sophisticated in the substance of medical ethics, little attention has been given to the processes these committees use to facilitate decision-making. In 1990, the National Institute for Dispute Resolution in Washington, D.C., provided a planning grant from its Innovation Fund to the Institute of Public Law of the University of New Mexico School of Law to look at what ethics committees can learn from facilitation and mediation techniques. The study's thesis was that, if adapted for use by medical ethics committees, facilitation and mediation techniques can be helpful to those bodies in case review consultations and in other internal committee processes. This article reports on that project.

HEC Member Perspectives on the Case Analysis Process: A Qualitative Multi-Site Study

“…Methods of writing and communicating recommendations also appeared quite diverse. This diversity of approaches and methods has already been identified (Swenson, 1992;West and Gibson, 1992;Fletcher and Siegler, 1996, p. 123), as well as lack of formal procedures noted in other studies. For example, Kelly and collaborators found that cases are discussed according to positions expressed by members, and not following a formal sequential method (Kelly et al, 1997, pp.…”

“…Furthermore, Bégin observed a similar phenomenon in Quebec's HECs ( ) ( ) (Bégin, 1995, p. 189). Many commentators of HECs have argued that the case analysis lacks rigor (West and Gibson, 1992;Bégin, 1995, p. 189;Kelly et al, 1997, p. 141;Rudd, 2002, p. 43) and, accordingly, HECs have been invited to clarify their procedures (Andereck, 1992, p. 49;Leeman et al, 1997, pp. 260-262;Aulisio, Arnold and Youngner, 2000, p. 65).…”

“…The fact that cases handed to HECs are described as conflicts and crises poses a number of challenges. DuVal and colleagues have recommended that members be trained to handle emotionally-charged cases (DuVal et al, 2001), and others also have suggested that HECs be trained in communication and mediation techniques (West and Gibson, 1992;Aulisio, 1999;Beyleveld, Brownsword and Wallace, 2002, p. 19). Additionally, many have suggested that there is a positive role for HECs in conflict resolution (Aulisio et al, 1992;Beyleveld, Brownsword and Wallace, 2002;Aulisio, 1999;American Academy of Pediatrics, 2001).…”

“…According to the literature, the benefits of case consultation include: 1) identifying and analyzing the nature of ethical uncertainties (Aulisio, Arnold and Youngner, 2000); 2) solving moral dilemmas (Simpson 1992;West and Gibson, 1992;Keay, 1994;Kelly et al, 1997;Aulisio, Arnold and Youngner, 2000); 3) promoting an inclusive consensus-oriented decision-making process (Keay, 1994;Fletcher and Siegler, 1996;Aulisio, Arnold and Youngner, 2000;; 4) facilitating conflict resolution (Waldron, 1992;Keay, 1994;Fletcher and Siegler, 1996;Aulisio, Arnold and Youngner, 2000); 5) improving the quality of healthcare by proactively identifying the causes of ethical problems (Fletcher and Siegler, 1996); 6) and helping prevent ethical problems by educating healthcare workers (Keay, 1994;Fletcher and Siegler, 1996).…”

“…All proposed methods and approaches have their own appeal and specific areas of emphasis (e.g., principles, narratives). However, in spite of the number of available methods, there are only a few published empirical studies dealing with the case analysis process (West and Gibson, 1992;Kelly, Marshall, Sanders, Raffin and Konig, 1997;Jurchak, 2000;Berchelmann and Blechner, 2002). Siegler and Fletcher state that "although formal ethics consultations have been performed for almost 20 years, there are few published reports in the literature that include empirical data on the process and outcomes of ECC" (1996, p. 124).…”