Since its establishment in 1995 by East Carolina University’s Brody School of Medicine and Pitt County Memorial Hospital (PCMH), the Bioethics Center has had as one of its primary tasks to support the work of the PCMH Medical Ethics Committee. The Bioethics Center has accomplished this task in a number of ways, including continuing service by Center faculty on the Medical Ethics Committee, assistance in planning and presenting educational programs by and for the Committee and its subcommittees, and participation in ethics case reviews provided by the Committee. Center faculty members have also played an active role in the development and revision of PCMH policies addressing bioethics issues. This column will describe several recent and ongoing policy development projects.

About five years ago, members of the Medical Ethics Committee identified a need for revision of the hospital’s policy governing advance directives and do-not-resuscitate (DNR) orders. The Committee established an ad hoc working group to address this issue. The working group, including representatives from the medical and nursing staffs, the Legal Affairs Department, and the Bioethics Center, chose to draft separate policies for advance directives and DNR orders. After several years of effort by the working group and the full Committee, new policies on these subjects were approved and implemented by the hospital. Both policies define decision-making procedures for patients with different types of advance directives and without formal advance directives. The DNR orders policy also establishes procedures for documenting, implementing, and reviewing DNR orders and for reassessing DNR orders prior to surgery or other invasive procedures.

Bioethics Center faculty also assisted the Medical Ethics Committee in drafting and implementing a formal procedure for providing assistance, upon request, to care givers, patients, and family members struggling with ethical questions regarding a patient’s care. A Case Review Subcommittee was created to respond to such requests by means of informal case review meetings designed to identify and explore the treatment options. In 1998, a second case review subcommittee, the Infant and Maternal-Fetal Case Review Subcommittee, was established to address ethics questions for those specific patient populations. At its meeting in September 2000, the Medical Ethics Committee approved the creation of an ad hoc task force to review and propose revisions to the current ethics case review process. The task force will survey medical and hospital staff and examine different approaches to ethics case review and ethics consultation. Through these efforts, the task force hopes to fashion a case review process that is more accessible and useful to all those who confront difficult ethical issues in the care of hospital patients.