Are Ethics Committees Merely Perfunctory? : Twenty years after the First JCAHO Mandate

In 1992, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued a mandate requiring hospitals in the United States to have a “mechanism for resolving ethics and value questions that arise in the care of patients”. Many hospitals fulfilled their obligation to provide access to ethics consultation services by having an ethics committee (EC) whose function has evolved to include education, policy, mediation, and case review in the interest of improving patient care and addressing the moral distress of physicians and staff. Though subject to interpretation, this requirement to have an EC for receiving hospital accreditation was repealed by the JCAHO in December 2022, creating a need for reevaluating and reimagining ethics services throughout our health care system. This paper will present the results of a qualitative research study performed at a 240-bed suburban community hospital. Interviews of 12 ethics committee members revealed a wide breadth of knowledge and experience, and exposed perceptions of educational gaps and varying degrees of engagement with ethical problem solving. Questions arose regarding the value of retrospective review, the limited agency of the committee to impact patient care and the moral distress of staff and institutional policy. An alerting common theme was that the ethics committee may have become merely perfunctory or procedural over the past 20 years. Interviewees were asked to reflect on the potential impact of the change in JCAHO requirements. Areas for improvement regarding optimal utilization of the ethics committee in an increasingly complex health care system were identified.

Iris Wertheim, MD – Gynecologic Oncologist, MBE candidate, Montefiore-Einstein