1. Salladay, Susan A. RN, PhD

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In yourEthical Problemscolumn, you often tell nurses with ethical queries to draw on resources such as their hospital ethics committee (HEC) or a clinical bioethicist. I don't think that's very realistic. At my hospital, the bioethicist was laid off last year to save costs. The HEC meets about once a year, and no one ever uses it because by the time someone responds, the problem has been resolved. Don't hospitals care about ethics anymore?-B.B., GA.


You express real concerns, and I echo them. Many hospitals are experiencing these problems. Hospital ethics committees and staff bioethicists were "trendy" a while back, but many hospitals have let their HECs dwindle into near oblivion and few employ full-time bioethicists.


Some facilities maintain an HEC only because The Joint Commission requires hospitals to maintain a problem-solving mechanism for ethical dilemmas. Many HEC members receive no formal training in health care ethics. Consequently, their recommendations may be too vague to help with real-world dilemmas.


Decades ago, HECs and bioethicists were valuable resources for patients and health care professionals agonizing over complex and unprecedented ethical problems, such as withdrawing treatment from terminally ill patients. Today, clinicians are more accustomed to handling these issues, and many organizations have developed policies and procedures to help resolve them.


Does this mean that HECs and clinical bioethicists are obsolete? Of course not. But like other resources, today's HECs need to be user-friendly. Many universities, nursing schools, and medical schools have developed clinical ethics centers to help this process take place. For example, visit the Center for Bioethics at Cedarville University at or The Hastings Center at