Hospital Ethics Committee
Is being on a breathing tube what my dad would have wanted?
When can my daughter start making her own health care decisions?
Can I refuse treatment if it is against my beliefs?
Are we doing the right thing? And what do we do if we don’t agree?
Medical care can be complex and confusing and can touch on many of our important values and ideals. The Ethics Committee at UNC Hospitals has experienced consultants available to help free of charge when there is an ethical dilemma related to health care.
Clinical Ethics Consultation
Why make a request?
An ethics consultation may help whenever the health care team, the patient, or the patient’s family has an unresolved ethical concern. A consultation can offer recommendations that the members of the health care team and patient (or patient’s family) may use in their decision-making.
A few examples include:
- Uncertainty as to who should make health care decisions or how to make those decisions for patients too sick to speak for themselves
- Conflict between values or religious beliefs and a recommended course of treatment
- Disagreement over whether starting, continuing, or ending treatment, such as breathing tubes or feeding tubes, is the right thing to do
- Moral distress about a health care decision
- A complex medical situation that also raises ethical concerns
Who can make a request?
Hospital and clinic patients at UNC Health Care, their family members, and any member of the health care team can request an ethics consult. There is no charge. The UNC Health Care System now includes seven affiliated hospitals and their clinics outside of Chapel Hill. If the patient is located elsewhere in the UNC Health Care System, please consult the box on the left to see who you should contact for assistance.
Other hospital staff (not directly involved in patient care) may assist interested patients, family members, or health team members by directing them to the service via the request line, this web site, or the Patient Handbook.
When should someone make a request?
People often tell the ethics consultation service that they wish they had requested a consultation sooner. If you think a consultation might be helpful, or just have a question about consultations, feel free to call and ask. It may be helpful to keep in mind that it can take some time (later that day or the next day) for the assigned consultant to respond to your request. That means that we cannot typically offer consultations on an emergency basis, such as requests made the day of discharge or an hour before a family meeting. The timing issue often arises because our ethics consultation service is staffed by health and ethics professionals who volunteer for this service in addition to their full time positions within the institution.
Are there times it is better to contact other hospital resources?
Yes, if you want to report poor medical treatment or have a financial or legal question or concern, please contact Patient Relations 984-974-5006. Our services help with difficult ethical decision making but do not offer remediation or other legal or financial solutions.
How do I make a request?
To request an ethics consultation, please call the Ethics Consult Request Line at 919-843-1470. During weekday business hours a person will answer your questions and if you wish to request a consult, will ask you a few questions to begin the consultation process.
If your call goes to our voice mail box during the day (or evenings and weekends), leave your name and a number to reach you. It is helpful, but not required, to include the patient’s name and a brief account of the issue you would like to discuss. It will speed our processes if you will spell your last name and that of the patient. (We cannot respond to requests without the name and contact information for the person requesting the consultation.)
The line is checked regularly Monday-Friday from 8:00 a.m. to 5:00 p.m. The line is not checked evenings, holidays, or weekends. If we do not return your call the same day, we will try to reach you by the end of the next business day.
What happens when a request is made?
- An ethics consultation is treated as a confidential aspect of patient care. When a consult is requested, a coordinator will gather some basic information from you and explain our procedures. The Director then assigns a lead consultant who will contact you and begin the consultation process. Typically the service will also alert the patient’s attending physician and the nurse manager of a request concerning one of their patients.
- The consultation could proceed in a variety of ways, depending on the request, the issue and the lead consultant’s initial assessment. It is common for the lead consultant to talk to the medical team, bedside caregivers and the patient or family. If someone does not want to be included in the process, or wishes to send another person in his/her place, we can typically accommodate these preferences.
- Sometimes the lead consultant will offer one or more meetings to discuss the issue and help identify permissible options. Additional members of the ethics consult service may also participate in the meetings.
- The lead consultant will offer recommendations relevant to the ethical issues identified. The ethics consultation is advisory only. Final decisions are made by the patient, family, and the health care team.
- The lead consultant will follow up with you, and sometimes with others involved in the consultation, to see if any clarification or further help is needed before closing the consult.
Committee Structure and Membership
The Hospital Ethics Committee has 30 members, representing a variety of disciplinary and community perspectives. Its members represent the major medical departments; other clinical departments, such as nursing, social work, and allied health; as well as pastoral care, hospital administration, and the community. Members bring experience and expertise in their areas; some members have specific bioethics expertise. Members and leadership roles within the committee are appointed by the Chief of Staff. Appointment of new members is staggered in order to ensure experienced membership at all times.
The full Committee meets monthly. Special meetings may be called by the Chairperson(s) on his or her initiative. See complete list of members.
Qualifications and expectations
To ask about membership to the Hospital Ethics Committee, please call 919-843-1470 Monday-Friday between 8:00 am and 4:30 pm. There is typically a waiting list for new members.
Arlene Davis, JD
Director of Clinical Consultation
Gary Gala, MD, F.A.C.S.
Rebecca Walker, PhD
Co-Director of Ethics Education
The Hospital Ethics Committee offers the following services:
- Clinical Consultation: Assists health care providers, patients and families in dealing with ethical questions related to hospitalization and treatment.
- Policy Advisement and Review: Assists with formulation of policies and/or guidelines addressing ethical issues. This service is available for the revision or development of institutional, departmental or service-related policies.