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Pioneering bioethics group disbands after 22 years
Bioethics Resource Group concludes its goals are met
The Bioethics Resource Group (BRG), a medical ethics education organization in Charlotte, NC, voted to shut itself down in December after 22 years in which it fostered hospital ethics committees and educated clinicians on advance directives and do-not-resuscitate orders.
According to D. Scott Lindsay, DMin, director of pastoral care at Presbyterian Healthcare in Charlotte, when the BRG first convened in 1985, fewer than 10% of hospitals in the Southeast had ethics committees, advance directives and living wills were not routinely sought out when patients were admitted, and programming in medical ethics was not easy to come by.
Lindsay, one of the original board members of the BRG, credits the commitment of the founding members to the success the organization enjoyed in bringing medical ethics education to the Charlotte area.
"Once the group was pulled together, there was agreement that there were issues that many of us had been thinking about, and they agreed these [individual health care systems] would pull together on them," Lindsay adds.
The BRG's goals were to:
Lindsay says that key to the group's decision to disband is the sense that it has accomplished its goals — ethics committees flourish at Charlotte area hospitals, and medical groups and medical schools provide ongoing opportunities for public and clinical education on bioethics issues.
"The danger could have been we could have continued to meet as a board and have wonderful programs, but where would the true contribution to the larger community be?" he asks.
"We know that the pioneering work done by the BRG in the field of medical ethics will continue through ethics education at the fine colleges and universities in the region and through the ethics committees at health care facilities," says BRG President Mark Stephens, PAHM, CMR, senior account manager for Pfizer Inc.
Over the years, the work of the BRG has included working with North Carolina hospitals as they created internal ethics committees; educating clinicians and the public about advance directives; and providing speakers and resource materials on enduring ethical issues as well as the ethics surrounding stem cell research, genetics, HIV/AIDS, health care access and reform, organ transplantation, and pharmaceuticals.
The membership of the organization reflects the wide net cast by health care ethical issues: Doctors, nurses, hospital administrators, chaplains, ethicists, lawyers, journalists, pharmacists, educators, and pharmaceutical professionals have been involved in the BRG's efforts throughout its life, Lindsay points out.
One of the catalysts in the birth of the BRG was the rise in the early 1980s of diagnosis-related groups (DRGs) and the push to classify patients based on the resources they consumed. Charlotte radiologist George Barrett, concerned that the Medicare regulations for cost-containment could have a negative impact on patient care, wanted to find a way to get the region's three acute care hospitals to work together to address the changes brought on by DRGs, and he concluded the way to get them talking was to get them talking about bioethics, Lindsay recalls.
Recognizing a mission accomplished
"For 22 years, this [organization] really met a need; at one time, we were told that there was none other like it in the country, and certainly it made it possible for hospitals in North Carolina and South Carolina to get good, solid medical ethics programs going," he says. By serving as a resource for education on developments in bioethics, the BRG put Charlotte health care providers in the position of being well-equipped to integrate changes such as the 1989 federal mandate that made advance directives the rule, rather than an oddity.
"We were able to get committees going, programs going in North and South Carolina, provide resourcing and educational events, so we were in a good position to do something with advance directives when the legislation came down," Lindsay explains. "And this was all happening before The Joint Commission started asking hospitals what provisions they were making for medical ethics.
Not that the BRG made for easy answers on developing ethical policy.
"It helped these health care systems have more conversations than they might have had, but yet, when we tried to develop a community-wide policy for [do not resuscitate] orders, a committee from the BRG and representatives from the two hospitals worked for 22 months and never could produce one," Lindsay says.
About two years ago, Lindsay says, some BRG directors began asking the hard question: Had the group served out its useful life?
A planning committee met for six months in early 2007, and in December made its recommendation that "the time had come to celebrate we've done and all the remarkable things being done at University of North Carolina at Charlotte and Davidson College [schools actively involved in BRG efforts], and to recognize that hospitals are taking care of themselves to a greater degree when it comes to bioethics and ethics resources," says Lindsay. "We did what we set out to do, and now ending it is a bold thing to do, but it's the right thing to do."