Low Volume Requests Equal Low Value Results

Written by: Dr. Kathy Gennuso

Most organizations today identify a need to incorporate some degree of ethics into their organization, typically due to fear of legal reprisal. In organizations where the ethics program is based on compliance, it is often the practice to educate the ethics committees, but rarely to provide education to the entire hospital.

Currently, an ethics program is required for certain certifications such as Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and Magnet. To support the need for education of this varied group of professionals possessing differing skills and educational backgrounds, dozens of training programs have been established in colleges, universities, medical schools, and hospitals across the United States, many of which offer undergraduate and graduate degrees, or certification programs, in bioethics. The oldest program in operation is the Kennedy Institute of Ethics at Georgetown University, which awards a masters and a doctorate in bioethics. Another common type of educational vehicle is an annual continuing education event, usually one to three days in length, focused on an aspect of bioethics. These meetings may be designed for internal, institution-wide educational purposes, or open to others, or both. Typically programs of this nature deliver basic knowledge and skills development.

In spite of the attention given to healthcare ethics, the frequency of requests for ethics consults has not increased. Research repeatedly identifies a low volume of requests; on average, consultation services were requested three times per year according to a national survey of more than 500 general hospitals conducted and published in The American Journal of Bioethics.  One of the giants of bioethics wrote that by 2012, he hoped the emphasis would shift from ethics courses, committees and consultants to an understanding on the part of most physicians and medical students that ethics is an inherent and inseparable aspect of quality clinical medicine. Maybe this statement was in support of a longstanding belief that in some way physicians would gain the moral knowledge and ability to effectively work with patients.  The healthcare community has not delivered to this vision. What must happen for this to change?