Planning for hospital ethics committees: meeting the needs of the professional staff

Hospital ethics committees (HECs) have historically been instituted "top-down", often ignoring the needs of the professionals and patients who might use their services. Seventy-four physicians and 123 nurses participated in a hospital-wide needs assessment designed to identify their perceptions of the functions of the HEC, determine which services and educational programs were most desired, and explore which forums were most preferred for discussion of ethical problems. Results indicated that utilization of the HEC focused around five areas of concern: withdrawing/withholding treatment, rationing and control of health care, children's rights, role of the patient and family in decisionmaking, and disagreements about treatment. Physicians and nurses differed widely in their attitudes. Perceptions about the appropriate functions of the HEC strongly influenced decisions regarding which HEC services to use. Needs assessment can play an important role in developing HEC goals and designing programs that meet the needs of professionals.