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9 HEC F. 7 (1997)

handle is hein.journals/hecforum9 and id is 1 raw text is: H E C FORUM C 1997 Jluwer Acadaeic Publishers 1997; 9(1):7-19. Printed in the Netherlands THE ESTABLISHMENT AND DEVELOPMENT OF NURSING ETHICS COMMITFEES CORNELIA M. FLEMING, R.N., M.P.H., C.N.A.A. Introduction The amount of attention given to ethical issues in healthcare has dramatically increased in recent years. The reasons are varied: the positive influence of the early establishment of healthcare ethics committees (HECs) has encouraged others to follow suit; the passage of the Patient Self-Determination Act in 1990 (1) and related state initiatives has focused attention on end-of-life decisionmaking; regulatory influences, such as that of the Joint Commission on Accreditation of Health Care Organizations (2) have caused healthcare institutions to develop mechanisms to address ethical concerns. All of this is quite positive and, while the quality of interventions may vary, patients' and families' ethical concerns are being heard. In institutions with established HECs, nurses are routinely included as members; however, the number of nurses able to participate at this level is small and not proportionately representative of nurses in clinical practice. Nurses in these settings and in other direct care settings are at the forefront of ethical decisionmaking and confront ethical issues on a daily basis. Some of these concerns do not warrant review by a multi-disciplinary committee but could and should be addressed in another forum. The development of mechanisms specifically designed to meet the ethics needs of nurses has not received sufficient attention in the literature, however; nor is it apparent that many institutions have introduced formal approaches. A survey of healthcare institutions (hospitals and nursing homes) in the metropolitan New York area, for example, uncovered only 15% with identified nursing ethics committees (NECs) (3). In another study, the Connecticut Nurses Association's Ethics and Human Rights Committee found that only 14% of the agencies surveyed in Connecticut had NECs (4). Anecdotally, various reasons have 7

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