Complex Craniofacial Cases and the Role of the Hospital Ethics Committee

ACPAClinician's Corner

Karla Haynes, RN, MPH, MS, CPNP

In an age when there is more surgical technology available and a more informed patient population due to internet and social media, it is no surprise that members of a craniofacial team will encounter an ethical dilemma from time to time. These predicaments may be handled by individual team members for whom the identified problem is most relevant, for instance, a surgeon may make the final decision about whether or not to offer surgery to a patient with a poor prognosis, but there is an alternative in most hospitals that may not be fully utilized; the ethics committee.

Hospital ethics committees are usually multidisciplinary and may include physicians, nurses, social workers, clergy and community members, among others.

While there may be some variation from institution to institution, ethics committees are often available to hear and offer consultation on challenging cases and provide feedback. Generally, rather than rendering a judgment about what “should” be done, an ethics committee consultation seeks to clarify the issues and goals at hand. Then, by applying common themes such as beneficence and nonmaleficence, the committee may also facilitate the communication of viewpoints and values held by both patient and care team members. The committee may offer alternatives to the approaches for care that have already been identified. The committee may guide collaboration to develop a unified care plan. Other times, an ethics committee consultation may not be sought during a crisis, but rather following a troubling event, in which case the ethics committee may help with debriefing. They may help to identify moral distress so individuals can seek some relief.

When a craniofacial team is at odds about a particular patient or plan of care, it may be worthwhile to approach the ethics committee, who may be able at a minimum to pose some salient questions to help re-focus the care team’s efforts, even when a full consultation is not warranted.

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