Hospital ethics committees in Israel: structure, function and heterogeneity in the setting of statutory ethics committees

Abstract

Objectives:Hospital ethics committees increasingly affect medical care worldwide, yet there has been little evaluation of these bodies. Israel has the distinction of having ethics committees legally required by a Patients' Rights Act. We studied the development of ethics committees in this legal environment.Design:Cross-sectional national survey of general hospitals to identify all ethics committees and interview of ethics committee chairpersons.Setting:Israel five years after the passage of the Patients' Rights Act.Main measurements:Patients' rights and informal ethics committee structure and function.Results:One-third of general hospitals have an ethics committee, with committees concentrated in larger facilities. Hospitals without committees tended to lack any structure to handle ethics issues. Committees tend to be interdisciplinary and gender-mixed but ethnic mix was poor. Confidentiality is the rule, however, legal liability is a concern. One-third of patients' rights ethics committees never convened and most committees had considered fewer than ten consults. Access to the consultation process and the consultation process itself varied substantially across committees. Some patients' rights ethics committees attempted to solve cases, others only rendered decisions. Informal committees often refused to consider cases within Patients' Rights Act jurisdiction.Conclusions:Despite statutory requirement, many Israeli patients and clinicians do not have access to ethics committees. The scant volume of cases shows serious discrepancies between practice and Patients' Rights Act regulations, suggesting the need for education or revision of the law. Heterogeneity in committee function demonstrates need for substantial improvement.

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

“…There are Healthcare Ethics Committees (HECs) offering consultations on clinical cases throughout the world (Ross, 2002;Rudd, 2002;McNeil, 2001;Wenger et al, 2002;Robles, 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).…”

Clinical Ethics Support in Contemporary Health Care

“…CES support is now a feature of at least some hospitals in Australia, Belgium, Bulgaria, Canada, Croatia, Finland, France, Germany, Israel, Italy, Japan, Lithuania, Netherlands, New Zealand, Switzerland and the United Kingdom, to name just a few (McNeill, 2001;Meulenbergs, Vermylen, and Schotsmans, 2005;Aleksandrova, 2008;Gaudine et al, 2010;Frikovic and Gosic, 2006;Guerrier, 2006;Louhiala et al, 2011;Wenger et al, 2002;Hurst et al, 2007a;Akabayashi et al, 2008;Bankauskaite and Jakusovaite, 2006;Dauwerse et al, 2011;Macdonald and Worthington, 2012;Hurst et al, 2008;Slowther, McClimans, and Price, 2012).…”

An eight-year follow-up national study of medical school and general hospital ethics committees in Japan

“…The Declaration of Helsinki requires that all biomedical research involving human participants, including research on identifiable human material or data, should be approved by an ethical review committee [3,4]. Today, ECs and their systems of peer-review for research protocol are used worldwide [5-16]. …”

“…Numerous studies have examined the activities and quality of ethical review of ECs among Westernized countries included Australia, Belgium, Canada, Israel, Italy, France, Germany, Netherlands, New Zealand, Spain, Sweden, Switzerland, the UK and the US [5-8,11-14,16-18]. Many of these studies have provided descriptive data on EC functions and structure [9-12,16]. Yet, despite the wealth of literature from Westernized countries, there persists a limited amount of research from Asia [10,15].…”