Hospital-based healthcare ethics programs vary in scope, activities, workload, financial compensation, and staffing. Researchers recently surveyed 600 hospitals to learn more.1

“National data regarding ethics programs can provide valuable input to national leaders in the field of bioethics,” says Marion Danis, MD, the study’s lead author and head of the section on ethics and health policy at the National Institutes of Health Clinical Center.

Data on the role of ethicists in hospitals and the financing of their work, “fills a knowledge vacuum,” Danis says. “These data are important on a long-term basis for sustaining and building the field.”

Ninety-seven percent of hospitals had established a healthcare ethics program (defined as “an officially sanctioned entity within a hospital that supports healthcare ethics by providing ethics-related services such as ethics policy development or ethics education.”) In 97% of hospitals with healthcare ethics programs, the program’s scope included clinical ethics functions.

Some ethics programs included additional functions: Ethical leadership (35.7%), regulatory compliance (29%), business ethics (26.2%), and research ethics (12.6%)

“These data are likely to be particularly important when institutions are under financial stress, budgets are tight, institutional demands are high, and various programs are under threat, as they are now during the pandemic,” Danis says. Other findings:

  • 77% of programs were responsible for providing ongoing ethics education to all staff.
  • Ethics program staff review existing policies more commonly than they are involved in developing new policies.
  • In 80.5% of hospitals, there is an ethics representative in executive leadership, while there are ethics representatives on other committees in 40.7% of programs.
  • 17.7% lead large-scale quality improvement ethics initiatives. 
  • There are more individuals performing ethics program work (and more are paid specifically for that work) at urban hospitals, larger hospitals, and academically affiliated hospitals.
  • The average total number of FTEs provided specifically for ethics program work was 0.3.
  • 76.3% of hospitals provided zero FTEs in specific financial support for ethics program staff. 

“It is surprising that designated funding for ethics program personnel is so limited. This poses a challenge to the development of the field of bioethics,” Danis says.

Bioethics training program leaders might struggle to place their trainees in financially well-supported programs, despite the fact hospitals seem to maintain substantial ethics programs.

  • Large hospitals (500 or more beds), major teaching hospitals, and urban hospitals were most likely to list resource shortages (e.g., time, money, staff, and training) as the greatest challenge facing their ethics programs. 
  • The smallest institutions (fewer than 100 beds) were more likely to list underuse of their services (staff were unaware of the service, did not understand the role of the service, did not appreciate its possible benefits, or did not identify a need for the service) as their ethics program’s greatest challenge.

“The other challenges they faced were lack of clarity of their programs, lack of leadership support, and lack of understanding of their role by healthcare providers,” Danis says.

REFERENCE

  1. Danis M, Fox E, Tarzian A, Duke CC. Health care ethics programs in U.S. hospitals: Results from a national survey. BMC Med Ethics 2021;22:107.