Health care ethics

At your hospital, the Committee on Medical Ethics is a medical staff committee. It answers to the Medical Executive Committee and the medical staff president, and its members are jointly appointed by the president of the Medical Staff and committee chair.

Although it is a Medical Staff Committee, its membership is multidisciplinary, including physicians, nurses, social workers, lawyers, and members of the lay public (for community representation).

Most members of the committee have received training in clinical ethics consultation, and were chosen because of their interest in resolution of ethical issues and their interpersonal qualities with patients and staff.

The hospital administration has engaged a consulting firm to “modernize” its structure. The consultants have advised converting the “old” social worker approach to the contemporary position of case manager. The consultants note that three social workers sit on the Ethics Committee.

The social worker members of the Ethics Committee were advised that they will no longer serve on said committee, and that their place will be taken by the manager of case management, who has no experience in ethics consultation, nor does she know anything about the history of Ethics Committee activities at your hospital.

The chair of the Ethics Committee is informed that three of his committee members are “out.” The chair is livid, and there is also an immediate reaction from all the rest of the committee members, most especially the medical staff members of the committee— something about separation of powers is mentioned.

You have been assigned by the hospital administrator to “handle this mess.” How would you go about doing so? If you had been told to handle the proposed committee reconfiguration from the very beginning, what would you have done differently from what was done? What change management practices would you have implemented to have these adjustments be handled better?