The Evolution of American Hospital Ethics Committees: A Systematic Review

Area of Science:

• Healthcare Management
• Medical Ethics
• Health Services Research

Background:

• Hospital ethics committees (HECs) emerged due to legal and professional mandates.
• Initial HEC formation lacked consensus on structure and function.
• The Joint Commission's requirements in the 1990s solidified HECs' role in patient care ethics.

Purpose of the Study:

• To systematically review empirical literature on Hospital Ethics Committees (HECs).
• To describe the evolution of HEC composition, administration, and activities over time.
• To identify gaps in current research and data regarding HECs.

Main Methods:

• Systematic review of empirical studies on HECs in the United States.
• Analysis of changes in HEC membership, leadership, reporting, and consultation volume over nearly 40 years.

Main Results:

• HECs have grown in size, with increased nursing and community member representation.
• Physician leadership of HECs increased, but their overall percentage decreased.
• Committees increasingly report to administrative bodies rather than medical staff, and consultation volume has risen.

Conclusions:

• HEC composition and function have evolved considerably, reflecting changing healthcare landscapes.
• There is a critical need for updated national data on HEC composition, administration, and consultation volume.
• Further research and professional standards are needed for quality improvement assessments of HECs.