Hospital ethics committees got their start in the early 1980s to guide decision making with patient care issues. Policy establishment was critical, especially when the issues of limitation of care, self-determination for health care, and privacy were venturing into nightly newscasts and private conversations. In the era of Dr. Jack Kevorkian, definitions of medical futility, legal battles over treatment decisions, and other high visibility events made the work of these committees even more important.
Dr. Fred Whitehouse and I co-chaired an ad hoc committee to create the first Henry Ford Hospital (HFH) Ethics Committee over 30 years ago. Our corporate attorney John Mucha was part of the committee at its inception. We were recently talking about this work, and he noted the HFH policy on withdrawal of care, modeled loosely on a Massachusetts General Hospital policy, is a policy that withstood the test of time. Literally hundreds of difficult decisions were made with its guidance.
What made me think about this was a recent piece in the Wall Street Journal by Drew Hinshaw. “Dr. Vallentine’s Decision,” which details the work of a Mediterranean rescue ship’s doctor, John Vallentine, ironically, a medical ethics professor from Australia. It details the story of a decision that Dr. Vallentine and the rescue ship’s crew had to make: help a critically ill man with a soaring fever and convulsions or proceed to reach a deflating rubber raft packed with migrants. The treatment of the man would delay the mission to find the raft before sinking, dooming the fates of many.
Ethics is about doing the right thing, all things considered. Relatively easy when there are straight forward, low consequence matters, or no dueling ethical principles. But our clinical lives and decisions are frequently not so simple. The three major principles of clinical ethics, autonomy (decisions for one self, care based on the individual), beneficence (doing good, healing and not causing harm), and universality (common framework of decision applying to all for the greatest good, prioritizing care when resources are finite) often times are in conflict with one another. Hence, the dilemma of clinical ethics decision making.
What Vallentine and the crew faced was a classic triage conflict: benefitting the one patient in front of you or the multiple others that may benefit from your care.
Our days fortunately do not have the agonizing drama of the WSJ piece, but I would not minimize the decisions made on each floor on a daily basis. To treat or not, is the patient able to make their own decision, is our care futile, which patient do I see first. And so we routinely move on with our care, within policy frameworks and deliberate decision making. Patients determining their care, care that benefits more than harms, treating by best evidence, doing the greatest good.
Under the guidance of Clinical Ethicist Karen Smith, LMSW, Ph.D., today’s HFH ethics program and its committee continues to assist clinicians in their work, providing highly-valued consultations, education and policy development to ensure our providers, patients, and family members make the best decisions possible, decisions that are ethically sound.
To those of you who work with the HFH Ethics Committee, thank you for all that you do.
About the HFH Ethics Committee
- Establishing an ethics curriculum is essential to ensure faculty and residents understand the framework of decision making and “speak the same language.”
- Fred Whitehouse and John Popovich, Jr. oversaw the creation of the first HFH Ethics Committee and its subcommittees – education, policy and clinical consultative ethics.
- Thought leaders, including Drs. Albert R. Jonsen, Mark Siegler and Eric J. Cassell, established and taught the principals of modern Western clinical ethics which ultimately helped guide the development of hospital ethics committees nationally.
- State networks, such as the Michigan Ethics Resource Network, initiated by Dr. Howard Brody from Michigan State University, assisted in developing effective ethics programs within hospitals.
- The HFH Ethics Committee consults on over 120 cases per year.
- For an ethics consult, call the Ethics Committee pager at (313) 705-5081.