Some people are eager to join the hospital’s ethics committee, but it does not always work out.
“Just because someone is a volunteer or is not being paid, it does not mean that they cannot be ‘fired,’” says Armand H. Matheny Antommaria, MD, PhD, FAAP, director of the Cincinnati Children’s Ethics Center.
Committee bylaws should address this possibility. There is an assumption that interest alone is a sufficient condition for membership in an ethics committee. “Committee members should be recruited purposefully to contribute specific skills, provide disciplinary diversity, or represent specific units,” Antommaria offers.
Ideally, ethics committee members are key opinion leaders in their areas of expertise. Their role, says Antommaria, is to bring the concerns of their specialties to the committee and convey the committee’s deliberations to their departments.
These are some examples of problematic ethics committee members:
• The super-eager volunteer who never shows up. “This is the main reason that I have had to ask members to consider resigning,” Antommaria says.
Sometimes, this member’s primary responsibilities change. The member may be embarrassed he or she has not fulfilled the commitment. If the change presents a short-term conflict with committee meetings, using patience may be the way to play it. “If it will be a long-term issue, members have been willing to resign,” Antommaria says.
A few members find the time requirements difficult. “These individuals stay on our membership rosters for a while,” says Erica K. Salter, PhD, associate professor of healthcare ethics at Saint Louis University.
But after some time passes, it becomes clear they cannot attend meetings. “It’s a fairly easy, and almost always mutual, decision that this particular committee isn’t a great fit for them,” Salter explains.
• The member who cannot engage in productive discussions. Antommaria sees the job of the chair to facilitate the discussion, which includes exploring potential biases. “It is possible that someone’s behavior is sufficiently antithetical to the committee’s mission and vision, he or she is unwilling to change, and needs to be replaced,” Antommaria offers.
When the issue is brought to their attention, the member might be willing to change, or might offer to resign. “Some people are less self-reflective and do not understand how their behavior is perceived,” Antommaria observes.
There are those who dominate the conversation, or are argumentative. They may be the first to a respond to a question. “This is problematic in part because the initial response frequently frames the subsequent discussion. It also does not show respect for others and their views,” Antommaria explains.
Interrupting and criticizing other members is a problem. “This is particularly problematic if the individuals are not open to changing their views or positions. Such individuals might also routinely criticize potential solutions without offering constructive alternatives,” Antommaria says.
One member spoke effusively about a recent publication to other members. When asked to describe the work’s thesis and rationale, the member curtly stated the committee would just have to read it. “Given that ethics committees are deliberative bodies, it is important that individuals not only voice their opinions. They must also be willing to justify them and potentially to change them,” Antommaria underscores.
• The member who focuses narrowly on one issue. A member “catastrophized” an issue by exaggerating its scope. “This made it difficult to accurately assess its likely effect and whether we needed to respond immediately,” Antommaria says.
That kind of single-issue orientation can derail the work of the committee. “If a person sees everything as being an example of the issue that is most important to him or her, it is potentially problematic, especially if this consistently sidetracks the conversation,” Antommaria cautions.
A nurse might continually focus on the need for more respect. A physician might constantly talk about the need for more autonomy. “It is important that members be able to identify a variety or diversity of issues,” Antommaria says.
Some dedicated ethics committee members show up and try to contribute, but are a poor fit for other reasons. “Those cases are far more difficult to address,” Salter laments.
An obvious lack of knowledge of clinical ethics is not always a deal-breaker. “Most committee members come to our committee without much formal ethical training, but with a real desire to learn more. The job of the leadership is to, at least in part, provide this education,” Salter says.
Likewise, Salter would hesitate to “fire” a committee member because he or she has not developed the interpersonal or communication skills to lead a consult or ethics mediation. “These skills have to be learned and practiced,” she says.
Ethics committees should consider conducting an annual membership audit, Salter suggests. Inactive members can be emailed and asked if they think the committee is still a good fit. “In some cases, the ethics committee leader might recommend other medical staff executive committees or institutional committees that have a different meeting schedule or seem to fit the interests of the individual,” Salter says.
An audit also provides a chance for ethics committee leadership to reflect on whether they are properly informing interested people of the expectations of membership and the reasons why someone is asked to leave. “In a way, ethics committee membership, like so much else in healthcare, should involve good informed consent,” Salter says.