Purpose:  To provide a forum for discussion of ethical and moral issues that arise in the medical care of the ECCS specific patients and to provide guidance for the caregivers and the healthcare team.

Business / Administrative Aspects of the ECCS:

• Meetings will occur every other month, as needed

• A budget will be prepared and submitted to the Chairman of the main WFUBMC Ethics Committee by August of each year.

• The Chairman of the ECCS in conjunction with the WFUBMC Ethics Committee Chairman will continue ECCS size, composition and quorum requirements.

Criteria for clinical ethics consultation:

• Only active clinical cases may be referred to the ECCS.

• Only active clinical cases that involve an ethical moral conflict (dilemma) may be considered for formal committee consultation. This determination will be done by the ECCS chairman after initial case review. Thus, contacts to the ECCS involving simple requests for legal or procedural information will not proceed to committee consultation.

• Should a question arise about the appropriateness of referral to the ECCS, the Chairman of the subcommittee will consult with the WFUBMC Ethics Committee Chairman.

Initiation of Clinical Case Consultation:

• The ECCS Chairman will determine who should be present at the consultation meeting from among the relevant parties (patient, patient's family, attending physician, house officers, nursing staff, social workers, pastoral care, etc.).

• The ECCS Chairman will determine the make-up of the consultation team that will be assembled from available members of the ECCS.

• The secretary of the WFUBMC Ethics committee will contact all relevant parties (noted in A and B above) to arrange a mutually acceptable place and time for the consultation meeting.

• The secretary of the WFUBMC Ethics committee will inform Risk Management of the ongoing case review.

• The consultation meetings will be held in a timely manner.

• Although the ECCS Chairman will ultimately determine the procedures to be followed  during a specific clinical consultation meeting, in general such meetings will consist of:

• Introduction of all persons

• Re-emphasis to all present regarding the intended outcome of the session, i.e., a summary of the discussion of moral issues and ethical reflection not necessarily the development of a consensus conclusion or authoritative directive.

• Presentation by the attending physician (or his/her designee) of the current clinical situation and moral dilemma.

• Presentation by others on health care team as deemed appropriate.

• Presentation by patient and/or family members.

• Dialogue and questions aimed at clarifying the ethical dilemma.

• After patient, family and health care team have left, further discussion/reflection by the ECCS team members in an effort to clarify and succinctly summarize the relevant issues, conclusions, and recommended options.

• A written summary of the consultation team's findings and recommendations will be prepared by the Chairman of the ECCS.  This document will be provided to the attending physician, requesting source (if different from attending), consultation team members, the WFUBMC Ethics committee chairman and the chief of Professional Services.  A brief summary prepared using appropriate language will be provided to the family.

• These summaries will not become a part of the patient's permanent medical record, unless specifically requested by the attending physician. However, a notation will be placed in the patient's chart stating that a consultation was completed and that a summary of the findings can be found on file with the Ethics Committee secretary.

• A record of the proceedings and findings will be kept on file by the WFUBMC Ethics Committee secretary.

• Follow up questionnaires will be sent to appropriate members of the health care team and family in a timely fashion in order to assess and improve the process of consultation at WFUBMC.

• The clinical consultation team shall adhere to principles of patient confidentiality throughout the consultation process.