Establishing an Ethics Team in a High Volume Women and Children's Service

Direct care-giver nurses and providers in the Perinatal setting, are ofen challenged when faced with difficult ethical situations or dilemmas. They often find themselves without resources required to best handle the issue. In order to provide the clinical staff with 24/7 access to ethical advice and consultation, Holy Cross Hospital established an on-call ethics advisory team. For the majority of physician/nurse-patient encounters in the Perinatal setting, there is an agreed upon scope, value, and desirability of the anticipated plan of care. Problems or ethical dilemmas arise when there is disagreement between the patient/family about the value or necessity of the treatment plan or when communication breaksdown.  As a result, parents, nurses, physicians, and others may experience uncertainty or conflict over how to respond to the situation. The ability to access a consultation team when conflict exists or in situations where moral/legal questions emerge, is critical to the ability to resolve the problem in a timely and effective manner and one that is consistent with the philosophy, mission, and values of the organization. The value of an ethics consultation rests in the team's ability to provide a forum for open discussion of the medical, moral, and/or  legal issues at hand. To facilitate access to the opportunity for this discussion to happen, Holy Cross Hospital created an on-call ethics team whose mission is to provide clinical ethics case consultation 24/7 as well as to draft and review institutional policy and procedures. Membership is multidisciplinary. Members are selected for their relevant knowledge and experience necessary to address the range of ethical issues faced in the Perinatal setting. Membership includes representation from the disciplines of nursing, medicine, social work, and pastoral care.