Handbook for Health Care Ethics Committees (review)

In the book Handbook for Health Care Ethics Committees published by Johns Hopkins University Press in 2007, the authors Linda Farber Post, Jeffrey Blustein and Nancy Neveloff Dubler take a comprehensive approach to cover all the parameters of Clinical Ethics. The book starts off with the fundamental ethical principles to show what health care is and ought to be.

The authors are widely published ethicists, with more than a few decades’ experience in the field. Here, they use their considerable teaching skills to convey the theory and practice of clinical ethics in such a way that even a lay person can easily comprehend how an individual’s rights should be and can be preserved when health care is delivered.

Major Topics

Part I describes a Curriculum for Ethics Committees as well as other important topics. Race, culture, and ethnicity play important roles in decision-making about and delivery of heath care. In the authors’ words, “How people confront decisions about health care is shaped in large part by the beliefs, attitudes, and values inherent in the cultures with the greatest formative influence on them. Choices about advance care planning, approaches to decision making, disclosure of information, life-sustaining interventions, and palliation are often informed by culturally determined notions of self-governance and destiny, truth telling and protection from harm, the power of language to reflect or create reality, filial obligation, the meaning of suffering, religion and spirituality, historical discrimination, and mistrust of health care or the health care system” (p. 00). [author: add page number of quotation here] Clinicians cannot be indifferent about such issues, and this reviewer would have welcomed even more discussion of them.

Endless research has long indicated that there are multiple factors determining access to care. In Chapter 8, “Justice, Access to Health Care, and Organizational Ethics,” the authors point out the potential pitfalls in the health care system and shed light on ways to ensure equity. This book reinforces the ideal that the most vulnerable group of the population, the poor and the underserved, not be subjected to neglect or paternalism, or exploited in the name of research.

In Chapter 10, sample cases are discussed to show how ethical theory meets clinical reality. Key legal cases in bioethics with different scenarios are also highlighted in Part VI. Rarely do we get to hear the stories behind the stories, and these sections of the book give clinicians examples of situation-types that they can cite when planning care and policy. Needless to say, this widens the appeal of this book beyond strictly academic readers.

The book also covers standard topics in clinical ethics, including Do-not-resuscitate (DNR), Do-not-intubate (DNI), Informed Consent, Disclosure and Confidentiality, Advance Directives, End-of-life Care, Hospice Care, and the ethical dilemma with rejection of recommended treatment, covering situations that nearly all health care providers face at some point.

This is a well-researched book with plenty of references. It is clearly the end product of a collaborative work through expertise drawn from specialists in different fields. The decision to include the Institutional Code of Ethics by Montefiore Medical Center in Part V in the Handbook for Health Care Ethics Committees was a prudent one. It can be used as a guideline for any governing body that regulates the ethical policies for health care providers. As the authors mention in the preface, it was formulated after the comparison of policies of several reputable institutions. Importantly, it suggests the inclusion of legal counsel to provide committees with assurance that their work crosses no legislated boundaries.

The Sample Clinical Ethics Committee Meeting at Montefiore Medical Center later in the book provides a guide for anyone sitting at an ethics committee to carry out his or her duties. A newly appointed member of such committee can use it rather than learning on a trial and error basis.

Handbook for Health Care Ethics Committees achieves additional credibility by virtue of...