Sentara Center for Healthcare Ethics
What is Health Care Ethics?
Health care ethics or "bioethics" is exploration of moral decisions or options available to resolve the dilemmas in the treatment of illness and disease. Beginning in 1947, and over the next forty years, the field of Bioethics took shape and earned an established place in academic medicine, the practice of medicine, research involving human subjects, and in public policy. The field of Bioethics includes medical science, the disciplines of theology and philosophy, the study of law and social sciences.
Medical discoveries after WWI significantly increased the physician’s ability to successfully manage the diseases of their patients. Penicillin was discovered in 1928, streptomycin in 1946, chemotherapy treatments like methotrexate to treat leukemia in 1947. In the 1950’s and 1960’ polio vaccines, anti-hypertensive medications, external cardiac pacemakers, cardiac catheterization, hemodialysis, full cardiopulmonary resuscitation, and intensive care units with ventilators ushered in new challenges in medical ethics. Sustaining life became more complex. Technology brought to the practice of medicine a new frontier in healing, and at the same time, the capability to prolong dying. Each new technology brought difficult choices and life circumstances, creating a need for patients, families, physicians and other health care providers to seek assistance for others with an expertise in bioethics.
During the 1960’s many conferences were held on the convergence of issues in medical ethics, theology, law, and social sciences. Tom Beachamp, Ph.D., and James F. Childress, Ph.D., wrote the seminal work, Principles of Biomedical Ethics, giving the discipline of Bioethics guiding principles of respect for autonomy, nonmaleficence, beneficence, and justice.
Health care ethics is the broad-brush term for many components of medical or clinical ethics, research and organization ethics. Today many issues make up the world of health care ethics. The complexity offers many challenges: nursing and physician shortages; medical technology; transplantation and organ donation; intensive care; withdrawal or withholding of medical treatment to allow natural dying; reproductive medicine; ethical issues related to surgery; pre-mature birth and fetal anomalies; dialysis; cardiac surgery and treatments; neurological devastation, and death.
Clinical ethics focuses on the day to day decisions at the bedside. End-of-life decisions take place every day in our hospitals, nursing facilities, home care and hospice. Clinical consultations, led by a team of individuals educated in health care ethics, facilitate discussions between patients, families, and health care professionals struggling with decisions which may alter forever the life of a human being and the family that love them. Each hospital has its own Ethics Committee, that meets regularly to review the consultation team cases.
Research ethics protects the rights of the individuals who agree to participate in research studies. The process includes informed consent, disclosure, confidentiality of medical information, and the belief the patient will not be harmed by the research. Institutional Review Boards (IRB) review and approve research prior to being implemented within Sentara.
Organization ethics has been supported by JCAHO since mid-1990. Sentara Healthcare has an organization ethics consultation team that facilitates an ethical discernment process to analyze the moral and ethical questions confronting health care today. This process assists leaders within the organization with an in-depth examination of their concerns, reflecting on values, beliefs, moral and ethical obligations in the provision of health care within our community.
The field of health care ethics continues to evolve as new technologies and research push us to discern the morally and ethically acceptable path to take.
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