As healthcare organizations become more complex, there is a greater need for ethical discussion. Ethics champion programs are one way of encouraging discussions, according to Angela Knackstedt, BSN, RN-BC, bioethics clinical coordinator in the Pediatrics Bioethics Center at Children’s Mercy Kansas City (MO).

The organization’s nursing ethics forum started in 1988 after two nurses participated in interdisciplinary discussion regarding the impact of the “Baby Doe laws” on the NICU. The law was enacted in the early 1980s for staff to report medical neglect after the widely publicized deaths of disabled infants after parents chose to withhold medical treatment.

“This experience made them realize that nurses needed more awareness and education regarding ethics and ethics resources,” says Knackstedt.

A more recent focus on “taking ethics to the bedside” focuses on nurse champions doing so within their own units and organizationwide.

“In addition, an annual day-long retreat allows a dedicated time for more in-depth ethics education, discussion, and strategic planning,” says Knackstedt.

The program helps mitigate moral distress, provides ethics education, and helps clinicians recognize and act on ethical issues, says Knackstedt, who co-authored a recent paper on ethics champion programs.1

Knackstedt says these steps are needed to create an effective program:

• Identify interested nurses who are passionate about ethics;

• Secure administrative support;

• Collaborate with ethics committees;

• Develop an ethics curriculum based on current issues (pediatric mental health, staff safety, health disparities, and self-care).

“With the support of ethics champion programs, ethics consultation can be utilized more because of the increase confidence in utilizing this essential resource,” says Knackstedt.

At Massachusetts General Hospital, the Ethics in Clinical Practice Committee (EICPC) was formed more than three decades ago. The goal to educate frontline clinicians in healthcare ethics has not changed, even while new ethical challenges have emerged. “Certain ethical issues challenge clinicians perennially,” says EICPC advisor Brian Cyr, RN, a nurse at Massachusetts General Hospital. These include care of vulnerable populations and helping families navigate end-of-life decisions.

“However, in the last few years, clinicians are increasingly raising concerns as they weigh the benefits and burdens that accompany ever-more advanced medical technologies that can prolong life,” says Cyr. These include continuous venovenous hemofiltration and mechanical cardiac support.

For some clinicians, this has led to moral distress. The EICPC has implemented several evidence-based strategies, including a formal structure for ethics support.

When requested, the EICPC also provides input on organizational projects with ethical implications. Recent examples include:

• Updating to the organization’s life-sustaining treatment policy;

• Improving the functionality of the electronic medical record’s advance care planning module;

• Creating a patient education brochure on healthcare proxies, titled “Planning in Advance for your Healthcare.”

“Our group offers practical ethics education and resources to our members, who then share these skills and resources with colleagues,” says Cyr.


1. Trotochaud K, Fitzgerald H, Knackstedt AD. Ethics champion programs. Am J Nurs 2018;118:46-54.


• Angela Knackstedt, BSN, RN-BC, Health Literacy & Bioethics Clinical Coordinator, Bioethics Center, Children’s Mercy Kansas City (MO). Phone: (816) 701-5297. Email: