Ethics education and value prioritization among members of U.S. hospital ethics committees

Calls for ethics education for members of hospital ethics committees presume that the effects and benefits of such education are well-established. This is not the case. A review of the literature reveals that studies consistently have failed to uncover any significant effect of ethics education on the moral reasoning, moral competency, and/or moral development of medical professionals. The present paper discuss this negative result and describes the author's national study of the value priorities of members of hospital ethics committees. This study discovered correlations between moral decision making and factors like age and type of institution where the committee operates. The results of this study also resemble those of previous studies in finding no correlation between ethics education and moral decision making. The author concludes that there is a need for more research on the effects of nonmoral personal, societal, and institutional factors on the moral reasoning of members of hospital ethics committees. Further, in the absence of any firm empirical basis, calls for ethics education for medical professionals and ethics committee members should be rethought.     

A national study of ethics committees

Conceived as a solution to clinical dilemmas, and now required by organizations for hospital accreditation, ethics committees have been subject only to small-scale studies. The wide use of ethics committees and the diverse roles they have played compel study. In 1999 the University of Pennsylvania Ethics Committee Research Group (ECRG) completed the first national survey of the presence, composition, and activities of U.S. healthcare ethics committees (HECs). Ethics committees are relatively young, on average seven years in operation. Eighty-six percent of ethics committees report that they played a role in ongoing clinical decision making through clinical ethics consultation. All are engaged in developing institutional clinical policy. Although 4.5% of HECs write policy on managed care, 50% of HEC chairs feel inadequately prepared to address managed care. The power and activity of ethics committees parallels the composition of those committees and the relationship of members to their institutions. The role of ethics committees across the nation in making policies about clinical care is greater than was known, and ethics committees will likely continue to play an important role in the debate and resolution of clinical cases and clinical policies.     

Research ethics committees: a regional approach

Guidelines for Institutional Review Boards (IRBs) or research ethics committees exist at national and international levels. These guidelines are based on ethical principles and establish an internationally acceptable standard for the review and conduct of medical research. Having attained a multinational consensus about what these fundamental guidelines should be, IRBs are left to interpret the guidelines and devise their own means of implementing them. Individual and community values bear on the interpretation of the guidelines so different IRBs attain different levels of effectiveness. In the Caribbean and Pan American regions there are few IRBs. Obstacles to the establishment and function of IRBs are exacerbated in developing regions like these by differences in language, literacy, and local value systems; education, administrative expertise, facilities, and access to information are also limited. A regional IRB network might facilitate more uniform ethical review in developing countries, and simplify IRB procedures. This revised version was published online in August 2006 with corrections to the Cover Date.     

Legal briefing: Healthcare ethics committees

This issue's "Legal Briefing" column covers recent legal developments involving institutional healthcare ethics committees. This topic has been the subject of recent articles in JCE. Healthcare ethics committees have also recently been the subject of significant public policy attention. Disturbingly, Bobby Schindler and others have described ethics committees as "death panels." But most of the recent attention has been positive. Over the past several months, legislatures and courts have expanded the use of ethics committees and clarified their roles concerning both end-of-life treatment and other issues. These developments are usefully grouped into the following eight categories: 1. Existence and availability. 2. Membership and composition. 3. Operating procedures. 4. Advisory roles. 5. Decision-making and gate-keeping roles. 6. Confidentiality. 7. Immunity. 8. Litigation and court cases.     

Hospital ethics committees: One of many centers of responsibility

Ethical reality is coextensive with human dignity. Therefore, one essential way to understand ethics is as the systematic effort to discern the imperatives of human dignity. Seeing ethics in this way highlights the fact that health care institutions have many centers of ethical responsibility (CERs) — the Chief Executive Officer, Board of Trustees, senior management team, etc. The Ethics Committee is only one such CER and not the most important one. These other CERs will benefit from identifying: (1) the fact that they are consistently dealing with ethical reality and making ethical decisions; (2) some critical elements of good ethical decision-making: (i) having the appropriate community; (ii) making the guiding value priorities explicit and specific; (iii) gaining skill in using the needed intellectual tools; and (iv) fashioning appropriate process and structure for discernment.     

Deductive reasoning and creativity: a cross-cultural study

The present cross-cultural study examined the relationship between deductive reasoning and creativity among college students (M age=20.4 yr., SD= .6) from Hong Kong (n=39) and the United States (n=38). Participants performed tasks designed to measure deductive reasoning, creative writing, and insight problem-solving, all in verbal form. No correlation was found between the performance for deductive reasoning and creativity as measured by creative writing. Insight problem-solving performance correlated significantly with that for both reasoning and creativity. Significant cultural differences favoring the American participants were only found on the creative writing and insight problem-solving tasks, both of which supposedly involve creative thinking. There seems to be cultural dependence for creativity but not for deductive reasoning which suggests a qualification of a strong cultural-relevance view positing pervasive cultural influences on human thinking processes.     

Cultivating ethics consultation: commentary on "The development of a clinical ethics consultation service in a community hospital

Conclusion: Simpson's article [in this issue, p. 124-130] provides us with needed data about the development and utilization of an ethics consultation service in a community hospital. It makes clear, however, how much further we have to go in developing guiding standards for practitioners and institutions. We need to learn much more about the effectiveness of ethics consultation in meeting well-defined goals and producing desired processes and outcomes before standards for credentials and accountability have a sound empirical basis.     

Language and reasoning: a study of temporal factors

The paper is concerned with the testing of psycholinguistic hypotheses by the use of deductive reasoning tasks. After reviewing some of the problems of interpretation which have arisen with particular reference to conditional rules, an experiment is presented which measures comprehension and verification latencies in addition to response frequencies in a truth table evaluation task.The experiment tests a psycholinguistic hypothesis concerning the different usage of the logically equivalent forms of sentence: If p then q and p only if q with respect to the temporal order of the events p and q. It is proposed that the former sentence is more natural when the event p precedes the event q in time, and the latter more natural when the opposite temporal relation holds.Although significant support is found for the hypothesis in the analysis of the latency data, it is only distinguished from an alternative explanation by detailed analysis of response frequencies, thus indicating the general usefulness of the paradigm adopted.     

Superior implicit memory: a pilot study

In this pilot study, implicit memory was examined in participants selected according to their scores on the Wechsler Memory Scale-Revised. Implicit memory was explored using a word-stem completion test after 24 participants had processed texts to be remembered. Variations in priming were observed among 12 Normal and 12 Good memorizers (Verbal Memory scores >110) following presentation of target words in the context of a coherent text. One intriguing result emerged: the magnitude of the priming effect varied by group, greater among Good memorizers than Normal memorizers.     

Perceptions of visible piercings: a pilot study

49 undergraduates were shown pictures of a man and a woman with piercings and with no piercings. The pierced model was judged to be less attractive and less normal than the nonpierced model. The pierced model was perceived as less intelligent, caring, generous, honest, and religious but more artistic and mysterious.     

fMRI of developmental stuttering: a pilot study

The purpose of this investigation was to explore the feasibility of fMRI in the study of developmental stuttering. Speech contrasts (loud versus silent reading) and language contrasts (reading of semantically meaningful text versus nonsense words) of six developmental stutterers and six nonstutterers were compared using a commercial 1 Tesla MR-Scanner (Siemens Expert). Results indicate that mapping cortical function in persons who stutter is indeed feasible, even with a 1TMR-system. Compared to normals the stutterers seemed to employ different and particularly less differentiated auditory and motor feedback strategies in speech. They apparently rely on auditory processing and on cerebellar contribution as much during silent reading as during reading aloud. Moreover, they showed a greater involvement of the right hemisphere in language processing, activating not only the typical language areas on the left but also and with equal magnitude the right side homologues of these areas. In spite of the promising results, at present several practical problems such as possible movement artifacts and possible masking through scanner noise still hamper a more straightforward use of fMRI in the study of developmental stuttering.