The policy forum. A panel of experts may provide the best guidelines for complex ethical decisions

Policies on complex issues such as the termination of life-sustaining treatment can be developed and implemented through a variety of methods, but a facility's ethics committee may be the most appropriate forum. Since committee members' interests are often too diverse to deal with specifics that are organizationally useful, the facility should establish a subcommittee of experts. This committee should include physicians; nurses; one or more hospital administrators; a trustee; representatives from social services, respiratory therapy, and pastoral care; a social gerontologist; and an ethicist. The members should keep open the doors of communication to their peers to address their concerns, incorporate their input, and expand the educational process. This will alleviate the frustration sometimes encountered in policy implementation, where those who must carry it out have had no part in its formulation. Once the subcommittee has drafted a policy, the full ethics committee should discuss and refine it before forwarding it to the administration. After the administration has accepted it, the medical staff, employees, patients, and families need to be informed.