Ethics Committee
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Ethics Committee

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What We Do

ACTIVITIES OF THE DHMC PROGRAM IN CLINICAL ETHICS
The work of the DHMC Program in Clinical Ethics consists of educational, clinical, research, administrative, and community outreach activities.

I. The DHMC Bioethics Advisory Committee

The DHMC Bioethics Advisory Committee consists of 22 members,  including:

  • physicians 
  • nurses
  • social workers
  • chaplains
  • therapists
  • ethicists
  • attorneys
  • hospital administrators
  • public members

Hospital services represented vary, but usually include:

  • ICU
  • CCU
  • PICU
  • NICU
  • internal medicine
  • geriatrics
  • neurology
  • psychiatry
  • surgery
  • pediatrics
  • obstetrics
  • risk management
  • nursing administration
  • house staff

The Committee meets monthly for a 90-minute meeting.  The agenda is set by the chair and consists of:

  • approving the minutes of the previous meeting
  • announcements
  • reports from the subcommittees
  • discussion of clinical consultation cases
  • new business
  • an educational presentation by an invited guest or Committee member

Members serve 3-year terms with reappointment if they remain active and interested.  Guests are invited at the discretion of the chair.  Every third meeting also is a meeting of the DHMC Infant Care Review Committee.

Education Subcommittee
The DHMC Bioethics Advisory Committee is charged to maintain the ethics education of its members, hospital professionals, and professionals in our community.  These functions are executed through the Ethics Education Subcommittee. 

The Subcommittee chair is Peggy Plunkett, APRN

The Education Subcommittee plans the following activities:

(1) The educational components of monthly Bioethics Advisory Committee meetings;
(2) Ethics educational opportunities for other services through maintenance of liaisons with each clinical service;
(3) The annual Bioethics Advisory Committee Training Day for ethics committee members from community hospitals

Policy Subcommittee
The Policy Subcommittee serves as an advisory body in drafting and review of hospital policies with ethical dimensions, in collaboration with hospital administration and senior leadership.  Examples of clinical policies with an ethical dimension include those concerning Do Not Resuscitate (DNR) orders, orders to limit the aggressiveness of treatment, palliative care, and informed consent.

The Subcommittee chair is Sandra Dickau, M.S.N.

Clinical Consultation Subcommittee
The Clinical Consultation Subcommittee meets whenever there is a consultation request that requires Subcommittee review.  The Subcommittee chair, Diane M. Palac, M.D. and the Bioethics Advisory Committee chair, James L. Bernat, M.D., receive requests and determine whether the problem can be handled expeditiously through discussion or if it justifies impaneling the full Subcommittee.  The Clinical Consultation Subcommittee meets for those cases requiring formal consultation, usually within 48 hours and often within hours if necessary. The Clinical Consultation Subcommittee is on call for emergency consultations after hours and on weekends. For information on the process of requesting a clinical ethics consultation, click here.

II. Ethics Educational Offerings

The following courses, seminars, and conference in clinical ethics are available at Dartmouth-Hitchcock Medical Center (DHMC) and Dartmouth Medical School (DMS). 

 Dartmouth Medical School Courses

  • Drs. James Bernat and Diane Palac teach clinical ethics to DMS-1 and DMS-2 students annually in the “On Doctoring” course.
  • Clinical ethics topics also are taught to DMS-2 students in the Scientific Basis of Medicine (SBM) course, including lectures on reproductive ethics, brain death, and palliative care. 
  • DMS-1 students spend an afternoon during orientation learning about the DHMC Code of Professional Conduct. 
  • Drs. Bernat and Palac offer a 12-week medical ethics elective each year to DMS 1 and 2 students.
  • DMS-3 students study hospice care during their internal medicine clerkship.  DMS-4 students study ethics cases during their course "Health, Society, and the Physician.” 
  • DMS-4 students also can take a reading elective in medical ethics with Dr. Bernat.

House Staff, Attending Staff, and Hospital-Wide Conferences
House officers in the DHMC postgraduate teaching programs can attend several ethics conferences.

  • Schwartz Rounds
    The Department of Pediatrics has held a monthly ethics conference for nearly a decade.  In the past two years, due to the generosity of the Schwartz Foundation, this conference has become “Schwartz Rounds,” a monthly conference in which pediatricians, pediatric house staff, students, nurses, and other professionals can discuss patient care issues, particularly ethical issues that evoke complex feelings.  
     
  • ICU Ethics Rounds
    ICU ethics rounds are held once monthly under the guidance of Drs. Bernat and Palac.  General Internal Medicine ethics conferences are held periodically.  Other departments have invited ethics speakers periodically.  The Department of Medicine sponsors the annual Chambers Visiting Professorship, a two-day visit to DHMC by a  renowned ethics physician-scholar.
     
  • Pediatric Ethics Visiting Professorship
    The DHMC Program in Clinical Ethics, the DHMC Department of Pediatrics, and the Dartmouth College Ethics Institute jointly sponsor the annual Pediatric Ethics Visiting Professorship.  This event takes place every May and features an internationally known expert in pediatric ethics who delivers two lectures, makes rounds with the pediatric house staff, and participates in a clinical rounds teaching conference.
     
  • Lahey Clinic Medical Ethics Newsletter
    The Lahey Clinic Medical Ethics Newsletter is published in conjunction with the DHMC Program in Clinical Ethics.  Dr. Bernat is Associate Editor of the Newsletter, and three DHMC professionals sit on the editorial board.  The newsletter is published three times each year and has a circulation of 40,000.  It attracts leading scholars in clinical ethics to present topics, discuss cases, and review ethics law.  It also publishes three annual medical ethics conferences held at Harvard Medical School.  The newsletter is distributed free to all DHMC physicians and DMS students. 
  • For a free subscription contact Patricia Busacker, managing editor.


 
III. Collaboration
 

The DHMC Bioethics Advisory Committee actively collaborates with several other committees, services, and boards within the medical center and academic community.

Within DHMC, these include:

  • Risk Management Service
  • Quality Management Service
  • Utilization Management Service
  • DHMC Confidentiality Committee
  • DHMC Code of Professional Conduct Advisory Panel
  • Physicians Health Committee

In our academic community, the Ethics Committee collaborates with:

  • DMS Committee for the Protection of Human Subjects
  • Dartmouth Ethics Institute
  • C. Everett Koop Institute

 

IV. Research

A few clinical ethics research opportunities are available.  Information can be obtained by contacting Dr. James Bernat. 

V. Community Outreach

The DHMC Program in Clinical Ethics is at the geographic center of the New Hampshire-Vermont bi-state area, and as such is the leading resource for clinical ethics expertise.  It maintains an active community outreach program with the following components.

  • New Hampshire-Vermont Hospital Ethics Committee Network
    This network of approximately 200 members representing the ethics committees of 40 hospitals and other health care centers in the bi-state area meets at DHMC twice yearly for a half-day educational program.  Dr. Bernat chairs the network and plans the programs.  Attendance is usually in the 70-90 range.  A fee of $10 is charged for the luncheon and educational materials.  Reservations can be made through Laura Stancs of Nursing Administration.
     
  • Clinical Consultation Service
    The DHMC Bioethics Advisory Committee will consider providing advice if requested by staff at community hospitals and nursing homes.  The Committee cannot travel for consultations but, in selected cases, meets at DHMC with professionals from area health care facilities.  Prime consideration is given to patients who are followed by DHMC physicians and hospitals and clinics with whom DHMC is affiliated.
     
  • Community Ethics Lectures
    Dr. Bernat and other Bioethics Advisory Committee members are available to give lectures in community hospitals, nursing homes, and elsewhere by individual arrangement.  Drs. Bernat and Palac, and Ms. Plunkett also are available to meet with ethics committee members in community hospitals by individual arrangement.