Ethical issues are part of everyday life in long-term care settings. They include respecting individual rights and privacy in an institutional setting, issues of autonomy in states of dependency, informed consent, resource allocation, conflict resolution and many others. In addition, addressing issues surrounding end-of-life care including advance directives, withholding and withdrawing life-sustaining treatments, do-not-resuscitate orders, determination of decision-making capacity, and use of surrogate decision-makers, requires skill and knowledge of basic ethical principles. Medical Directors should take leadership in assuring that their facilities have appropriate mechanisms in place for addressing these issues.
Ethics committees are an acknowledged means of fulfilling these specific roles in the institution:
- They are used to assure the development, promotion and protection of values.
- They provide an opportunity for multidisciplinary dialogue which clarifies ethical and legal concerns, considers aspects of fiscal responsibility, and guides decision making for complex dilemmas.
Ethics committees can fulfill these roles by providing the following functions for issues of an ethical nature:
- Policy development and review
- Quality assurance activities
- Education
- Resource for staff, clinicians, administration, patients, families, and community.
- Monitoring judicial decisions and legislative action
- Consultation and review of case-specific dilemmas
Members of ethics committees should be provided with sufficient training, education, and institutional involvement to allow reliable ethical analysis of issues brought to their attention. Committee composition should be reflective of the community which the facility serves.
AMDA recognizes the significance and helpfulness of ethics committees in long-term care facilities and strongly encourages their development. AMDA will provide support, resources of education, expertise, and guidance for the establishment of ethics committees in long-term care facilities.