A Survey of Ethics Review Committees in New York State Hospitals: Key Findings and Lessons.

Abstract

New York State’s Family Health Care Decisions Act (FHCDA) governs health care decisions for patients who lack capacity and who did not decide in advance or appoint a health care agent. It also requires each hospital, nursing home, and hospice to establish an “Ethics Review Committee” (ERC) to perform certain advisory and dispute resolution functions and, in some instances, to approve or deny proposals to withdraw or withhold life-sustaining treatment. Although the ERC requirement has been in effect since 2010, not much is known about ERCs. This study involved sending a de-identified email survey to ethics professionals at New York State hospitals. Survey results found that hospitals have employed a variety of approaches to organize and operate their ERCs, that there is variability in the relationship between their ERC and other hospital ethics committees or services, and that there are differences in the capabilities of smaller or non-system hospitals as compared to larger or system hospitals. The study also found that many ERCs do not offer or require training for members, do not meet regularly, and do not have members who have ethics expertise. We suggest that ERCs could benefit by addressing those areas and others, and we offer some recommendations. Finally, we found that hospitals regard their ERCs as moderately successful in performing many of their key assigned functions, including end-of-life decision-making in cases where they have that authority.