Ethics Committee Core Curriculum

SHHV-SBC Task Force on Standards for Bioethics Consultation

Meeting One: May 24-26, 1996 Minutes

Prepared by Mark Aulisio, Ph.D.
Executive Director

The following are the minutes of the first meeting of the SHHV-SBC Task
Force on Standards for Bioethics Consultation (henceforth referred to as
TF).  As many of you know from previous discussions on the list, this is a
task force designed to study the need for standards regarding bioethics
consultation.  We will be meting 6-8 times over the next two years
(Members of the TF are listed at the end of this message). The TF decided
to place these minutes on the MCW list to better inform the bioethics
community about our work.  Please feel free to send your comments and
suggestions regarding these meetings to any TF member, but particularly
Bob, Stuart and Mark.

These minutes include summaries of each of the presentations made at
meeting 1 and a synthesis of discussion in the "Points of Substance and
Process" section which follows the presentation summaries.  Except where
noted otherwise, each presenter has prepared his/her own summary.

STUART YOUNGNER (MISSION OF THE TASK FORCE)
(Prepared for S. Youngner by M. Aulisio)

Dr. Youngner commenced the first meeting of the TF with a discussion of
what the TF co-directors, Bob Arnold and Stuart himself, and the executive
director, Mark Aulisio, thought to be the primary mission of the TF.
Stuart's comments involved background information on the genesis of the
TF, central questions which the TF must seek to answer, and the kinds of
documents which should result from the TF.

Background Information:  The TF came into being over the course of the
last several years through the work of a variety of individuals and
groups.  The sources of funding for the project are quite diverse. They
range from the grass roots sources such as the academic centers for
bioethics and ethics committee networks, to national organizations such as
AMA, AHA, JCAHO, SCCN, SBC-SHHV, etc. to the primary contributor, the
Greenwall Foundation.  The funding has come together in light of two
background assumptions under which the TF will operate.  First, the field
of bioethics has emerged over the years as an inter-disciplinary field.
It is the opinion of nearly everyone connected with the field that its
inter-disciplinary nature is a great strength.  The variety of funding
sources for the TF reflects the rich diversity present in the field.
Second, whether it is thought to be an asset or a liability the fact is
that clinical ethics consultation is a reality.  It actually goes on in
clinical settings.  It helps to meet JCAHO requirements.  It is actually
affecting patient care in different contexts. The reality of clinical
ethics consultation involves issues of regulation and administration,
accountability (legal and moral), financial support, competence, and,
among other things, effects on patient care.  In the context of this
reality increasing numbers of people are announcing themselves as
"ethicists" and offering ethics consultation services.  Indeed, there have
been recent legal cases involving "ethics consultants" who appeared to
have little or no training in ethics.  The reality of clinical ethics
consultation is part of what drives the need for a thorough consideration
of whether some sorts of standards need to be set both for ethics
consultation itself and for the education and training of those who will
function as ethicists in clinical settings.  Dr. Youngner emphasized that
programs are already being set up which presuppose (1) certain standards
for the education and training of those will function as clinical
bioethicists and (2) certain views about the nature of clinical ethics
consultation.  It might be a serious mistake if a group of those who are
viewed as leaders in the field failed to at least consider the question of
standards for clinical ethics consultation.  This is what this TF will do. 

Central Questions Which the TF Should Consider:  The first question which
Dr. Youngner proposed that the group consider is "What are the core roles
or functions of the health care ethics consultant?"  This question must be
answered because it will impact other questions which this TF might need
to answer:  Shall health care ethics consultation be offered by
individuals, groups, or both?  What are the goals of health care ethics
consultation?  What are the necessary knowledge, skill, and character
requirements for the health care ethics consultant?  What, if any, are the
proper educational and training requirements for the health care ethics
consultant?  What, if any, are the proper credentialing and/or licensing
requirements for the health care ethics consultant?  Dr. Youngner
emphasized that no presuppositions are being made about what the TF's
answer to any or all of these questions must be.   However, there is one
major presupposition regarding the nature of the TF's mission.  This
presupposition is that the TF's approach will be more practical and
pragmatic than academic.  This means that the TF will aim to adopt a
position and make recommendations rather than merely to outline possible
alternatives.  The TF will attempt to provide a sound justification for
its position, while recognizing that it may not be able to meet every
possible academic objection.

Products of the TF:  A "white paper" will be issued by the TF.  It will be
a shorter paper which sets out the conclusions of the TF. This is the
product that has been promised to the TF's benefactors. The paper will be
widely disseminated as the recommendations of the TF.  The TF  will also
probably want to issue an edited book (like the Canadian project issued).
Lastly, the TF may want to issue a series of articles that will be
published in a major journal for the consumption of the medical and
bioethics community.  Dr. Youngner emphasized that the likelihood of
disagreement among TF members about various issues should be recognized at
the outset.  Because of this there will be room for minority dissent,
however Dr. Youngner suggested that a  simple majority should suffice for
a TF recommendation.  Lastly, Dr. Youngner emphasized that the TF process
will be open.  In light of this, regular updates will be given to the
SBC-SHHV as well as the MCW.  Dr. Youngner suggested that minutes of each
meeting should be kept.  These minutes will then be sent out to all TF
members.

PAUL SCHYVE (JCAHO AND ETHICS CONSULTATION)

Since 1970, the Joint Commission on Accreditation of Healthcare
Organizations has set expectations in its accreditation standards for
hospitals (and, subsequently, long term care, home care, ambulatory care,
behavioral health care, network, and laboratory organizations) that
require the organization to respect the patient's rights. These rights
include those for humane treatment, respect, non-discrimination, physical
privacy, confidentiality, and participation in decision making through
fully informed consent and the right to refuse treatment (with special
emphasis on advance directives, withholding of resuscitative services, and
foregoing and withdrawing of life sustaining services). This obligation to
respect the individual's rights as patient was to expand to include the
individual's rights as consumer, first in 1978 (the right to a detailed
explanation of an itemized bill) and, most recently, in 1994 and 1995.

These recent revisions required the accredited organization to have a code
of ethical business behavior that addresses practices in marketing,
admission, transfer and discharge, and billing, and relationships of the
organization and its staff to other providers, educational institutions,
and purchasers (i. e., "conflicts of interest"). The standards for health
networks (e.g., integrated delivery systems, health maintenance
organizations, health plans, preferred provider organizations) include the
requirement that the network's code of ethical business behavior "protect
the integrity of clinical decision making, regardless of how the network
compensates or shares financial risk with its leaders, managers, clinical
staff, and licensed independent practitioners" (e.g., physicians).  In
addition, the standards, in effect, prohibit "gag clauses" by requiring
that an accredited health plan's enrollee be informed of the scope of
services in his or her benefit package, which services are excluded, how
to obtain excluded services, and any significant alternative treatments or
procedures for his or her condition or illness.

Within this context, since 1992 Joint Commission standards have required
that an accredited organization have a mechanism(s) for consideration of
ethical issues that arise in the care of patients and to provide education
to staff and patients about these issues. While not prescribing a specific
mechanism, the standards identify ethics committees and ethics consultants
as effective ones. Dr. Schyve suggested that these existing mechanisms can
be expanded in their scope of services, composition, and accessibility to
staff to encompass ethical issues arising in business practices.  This
recommendation stems from two sources:  1) clinical ethics and business
ethics are not easily differentiated  (e.g., too aggressive marketing and
admission practices can result in  unnecessary care, which carries a risk
to the patient's health and safety); and 2) the expertise that resides in
the current mechanism(s) is applicable to business ethics also, namely,
knowledge of ethical principles and of ethical reasoning, and skills in
communication and teaching others, and in facilitation of discussion and
conflict resolution. 

These skills and knowledge should be possessed by all ethics consultants,
which has raised the question of potential value of guidelines or
standards for ethic consultants, and of their certification.  Based on
Joint Commission experience, Dr. Schyve recommended: --clarity on the
focus of standards- are they for  the practitioner (i.e., the consultant),
or for the intervention (i.e., the consultation), or for specific
situations (e.g.,  end of life)?

--clarity on their purposes - are they advice for improvement, or expected
behavior unless an exception is justified, or required behavior for
purposed of reimbursement, or a legal standard for malpractice?

--clarity on the type of standards - are they for structures (e.g.,
education, experience, number of consultants), or for processes (e.g.,
behavior of the consultant on a consultation), or for outcomes (e.g.,
satisfaction of physicians, nurses, patients, and patient's families with
the process and result)?

--clarity on the stakeholders who should be involved in setting guidelines
or standards - e.g., patients and consumers, practitioners, provider
organizations, purchasers, regulators and accreditors, society.

--continuous improvement in the standards through a feedback loop based on
measurement of outcomes. 

--principles for standards development that include a customer focus; an
emphasis on what is to be achieved through good performance of systems,
processes and people; and avoidance of structural requirements that may
discourage continuous improvement in both
effectiveness and efficiency through innovation. 

CHARLES BOSK (SOCIOLOGICAL NATURE OF PROFESSIONALIZATION)

There is a large literature on the efforts of various occupations to
professionalize.  Some of this literature is theoretical; much of it is
extended case studies.  The major lesson of this literature is that while
many occupations try to professionalize few are successful.   In general
there are two views of the professions with many variants of each that are
found in the sociological literature.  The first view is the classic or
traditional model of the professions and derives from the writings of
Durkheim, Carr-Saunders and Wilson, and Parsons. The second view which
grew alongside of, and in opposition to, the first is an "anti" model of
the professions.  It turns all of the propositions of the classical model
on their head; it is derived from the writings of EC Hughes, Freidson,
and, more contemporaneously, Sarfitti-Larson.

In the traditional model, professions are separated by a clear boundary
from other occupations.  Professions are marked by both practice in an
area of what Parsons calls high value salience to society (medicine and
health, clergy and salvation, law and justice, academics and cognitive
achievement) and by the spirit of professional service.  Professional
status is attained by long adult socialization in some specialized body of
disciplinary knowledge (hence professional status is attained through what
sociologists call universalistic achievement), an internal code of ethics
which causes the group to be self-regulating, by an orientation toward the
collective good, and by state recognition through certification and
licensing. 

In the "anti" view,  the claim is made that there is some confusion: the
claims that professions make about their practice are mistaken for
reality.  In this view, which often takes what may be called a labeling
theory view, a profession is any group which claims the title and has that
title successfully recognized by others, especially agents of the state.
There is really no bright light test that separates professions from other
occupations.  In this view, the long adult socialization in a disciplinary
body of knowledge is seen as a device to restrict entry in the market; the
code of ethics, a device to avoid external regulation; and the
collectivity orientation, an empirical claim rather than an a priori
theoretical property.  In this view, professions are marked by their
political, economic, and status success rather than any inherent set of
properties.

Where all this comes in for bioethics consultation is in the need to
recognize that there is something inescapably elitist, anti-democratic,
and perhaps self-serving about writing standards, minimal qualifications
for practice, and the like.  This is not say that these are not all
necessary.  What it suggests is that any group engaged in the
self-conscious fashioning of its occupational identity needs to be aware
of these.  It also suggests that there are two elements in making claims
about an occupation.  First, there is getting those who practice to accept
these claims, see their relation to better outcomes, and enforce them.  We
might call this the problem of leaders and followers.  Next there is the
issue of getting society to recognize the claim of those within the
occupational group.  This is a problem of practitioners and publics.

To sum, the tensions between expert knowledge and democratic principles
has been a recurrent theme in sociology since we sociologists began
writing about professions.  Indeed, one of the most provocative statements
of this theme is found in Weber's "Science as a Vocation" first published
in 1918.  In a discipline such as bioethics in which autonomy is a core
value these questions are particularly acute.

FRANCOISE BAYLIS (ON THE CANADIAN PROJECT)
(Prepared for F. Baylis by M. Aulisio)

Dr. Baylis' presentation focused on the work of the Social Sciences and
Humanities Research Council (SSHRC) Strategic Network which produced The
Health Care Ethics Consultant, (THCEC, 1994, ed. Baylis).  In particular,
Dr. Baylis focused on the Network's work on certification for health care
ethics consultants and the Profile of the ethics consultant.  Her remarks
could be broadly categorized as falling under issues of (1) process, and,
(2) content.  By way of introduction to these remarks Dr. Baylis offered a
general background to the project and its membership.

Background:  The SSHRC funded the network (1991) in order to look into the
problem of the charlatan in ethics consultation.  This problem is
motivated both by the practice of some in the field that others consider
to be charlatans and by the additional difficulty that without some sort
of educational or training criteria administrators might not be able to
identify good candidates to serve as ethicists in the clinical setting.
The composition of the network was quite diverse even though no specific
effort was made to have various constituencies represented.  There were
only two group members with full-time academic appointments.  All other
group members were practicing clinical ethics consultants.  One noticeable
omission in group membership was that of nursing (this was due to
circumstances at the time that were beyond the control of the network).
It should be noted that the membership of the Network and the authorship
of the articles which appeared in THCEC diverged.  For more background
information see the THCEC.

Process:  At the outset of the project the "rules of the game" were
clearly stipulated.  These included (1) that the objective of the group
need not be to achieve consensus, (2) that members would not engage in
"turf protection" or agenda making, and (3) that responses to comments
would not imply that others were engaging in "turf protection" or "agenda
making".  The Network agreed that consensus "does not mean that everyone
thinks that the decision made is necessarily the best one possible, or
even that they are sure it will work.  What it does mean is that in coming
to that decision no one felt that her position on the matter was
misunderstood or that it wasn't given a proper hearing.  Hopefully,
everyone will think it is the best decision; this often happens because,
when it works, collective intelligence does come up with better solutions
than could individuals" (Women's Encampment for a Future of Peace and
Justice, Seneca Army Depot, N.Y., Resource Handbook, 42). 

The meetings were fairly unstructured with no set agenda or goals that had
to be achieved.  Each meeting picked up where the last left off (as the
members saw fit).  To set things in motion, the first question the group
agreed to address was "What is it that the ethics consultant should do?"
This conversation led to the development of the survey instrument which
was, in turn, used as a reality check for the Profile.  In order to set
the survey, the Network needed to develop a definition of the scope of
ethics consultation.  The working definition agreed upon was that anyone
who is involved in consultation on ethical issues in clinical cases or
research, ethics committees, research ethics boards (or IRBs in the
States), or policy formation committees in health care institutions should
count as falling within the scope of ethics consultation.  Teaching,
except within the context of these activities, did not fall within the
purview of the Network's focus. 

Overall the process was very participatory and open.  The survey was
widely distributed.  Information gathered was widely disseminated.
Feedback was frequently sought through the presentation of survey results,
working papers, etc. (especially on the Profile and certification pieces
of the project).  THCEC was sent to all who participated by answering the
survey.  And, a voluntary directory was compiled of those who identified
themselves as ethics consultants. The directory was then widely
distributed for networking purposes. Throughout the entire process
considerable shifting of views occurred.  Indeed, the novel idea of the
Profile was a result of the ongoing and evolving conversation.

Content:  Dr. Baylis' focus on content centered around the Network's work
concerning certification and the Profile. 

Regarding certification, Dr. Baylis highlighted two of the concerns that
are reflected in the chapter on certification in THCEC (for more detail
see THCEC, 11-24), gate-keeping and character traits.  The first concern,
gate-keeping, deals with who shall control entry into the field.  Of
particular concern for the Network was the danger of certification for
quashing diversity on the field.  In addition, certification, on the
Network's view, would run into the problem of the impossibility (for
political reasons) of being able to exclude any of the "grandfathers of
bioethics"  including "charlatan" grandfathers.  Thus, in at least one
important respect, certification would fail to achieve its stated goal,
i.e. the ousting of charlatans.

 Regarding character traits, the Network thought that without certain
character traits (virtues) the knowledge and skills suggested in the
Profile would be of very little use.  Yet, it is clear that "certifying"
for character is a very dubious enterprise.  Responses to the Network's
position on certification were very favorable both in feedback at
presentations and book reviews.  Dr. Baylis did state that many within the
Network thought that the move toward certification might be inevitable.
The Profile marked the Network's contribution to that debate.

Regarding the Profile, Dr. Baylis explained that the idea for it was the
result of the evolving conversation of the Network.  The Profile is meant
by the Network to be of use in both a "top-down" and a "bottom-up" way.
By the former is meant that the Profile should be of use for those in
positions to hire ethics consultants by allowing them to know what to look
for to suit their specific institutions.  The Profile could be of use in a
bottom-up fashion by both students and practitioners as a way of planning
education and continuing education toward the end of being an excellent
ethics consultant.  The general response to the Profile has been
favorable, however one recurring criticisms has been that the Profile is
far too onerous.  The Profile has been said to represent an ideal which
only a god might be able to fulfill.  Dr. Baylis emphasized that no one
has taken up the challenge issued by the Network to provide a cogent
argument as to why any element of the Profile should be deleted.
Ironically, though the Profile has repeatedly been said to be too onerous,
some of the responses to it seem to be adding, rather than subtracting,
elements. Dr. Baylis emphasized that the character traits identified by
the Network in the Profile were "ideals" for which ethics consultants
ought to strive, while the knowledge and skills identified in the Profile
should be viewed as "minimum requirements."  Dr. Baylis
suggested that at least two knowledge requirements should be added to the
Profile (1) sensitivity to knowledge necessary for one's chosen area of
practice (most ethics consultants specialize in one or two areas [e.g.,
ICCU or Oncology, etc.]), and, (2) sensitivity to knowledge of power
asymmetries in clinical practice.
 



JOHN FLETCHER (THE VIRGINIA PROGRAM)

 Guidelines of the Virginia Bioethics Network For Bioethics and Clinical
Ethics Committees

 Providing a process for ethics consultation is one of fourservices of an
ethics program in a health care setting.  The other three are:  education
for clinicians, patients, surrogates, and the broader  community; policy
studies on request with recommendations to  administrators and policy
makers; and targeted research on the deepercauses of ethical problems in
the institution and community that are brought to the attention of ethics
committees and consultants. The task of deciding what kind of education
and training is required for ethics consultation should not be divorced
from the skills required to provide these other services.

 In the broader sense, the need to identify, describe, and evaluate the
services of an ethics program is deeper than the need for which  the Task
Force is assembled, i.e., to study the need for training, education, and
possible approaches to certification of ethics consultants. Probably 95%
of those who are engaged in ethics consultation and the  other services of
ethics programs are members of ethics committees in  health care
organizations (HCOs): hospitals, long-term care  facilities, home health
agencies, hospices, HMOs, etc.  The condition  of many of these groups is
very marginal, fragile, and unsupported.  Many of them are in a condition
of "failure to thrive," i.e., those  who need their services the most do
not use them, the members are untrained for their tasks, they are
unconsulted in true ethics emergencies, etc.  Even if the committee has
progressed out of this condition, it may be now in a condition of living
from crisis to crisis.  Ideally, the group could attain a condition of
being sufficiently supported and trained to render its three primary
services and also conduct research aimed at prevention of the chronic
ethical problems that tend to dominate its agenda. 

 In 1990, UVA developed an outreach and training program, first aimed to
help hospitals to start or strengthen their ethics committees and  to cope
with the "failure to thrive."  The first model of "Developing Hospital
Ethics Programs" was a 21 day training program once a week in the Fall and
Spring.  The program has evolved today into a 6 1/2 day training program.
Hospitals send 2 persons into training with a commitment to develop a work
plan for the first year.  The program has now served more than 125
hospitals and 30 long-term care facilities.  The learnings from this
program and the vast needs to be met led to the founding of the Virginia
Bioethics Network in 1992 and to an early task of the VBN, i.e., to
explore the question of standards for what counts for quality in the
process and performance of an ethics program. 

 In 1993, VBN began a process of debate and drafting of guidelines for
assessing the quality and accountability of ethics committees'  process
and performance in its primary three services as well as for  the
education and training of members to render these services.  The
experience of the VBN in exploring and experimenting with the concept  of
standards that is most relevant to the task of the Joint Task  Force.

 What is the need for guidelines (standards)? First, there is  tremendous
diversity between committees with respect to process and  performance.  In
ethics consultation alone, some committees are voting on life and death
questions and making decisions for others.  Other committees are very
non-directive and provide consultation at the bedside that is educative
and mediative in nature, aimed at helping the decision makers reach a
resolution of the problem.  Secondly, there is a need for quality
assessment of ethics programs and their performance. Third, the JCAHO
requirements stress the TQM approach to quality assurance, which begs the
question as to why ethics programs escape this process.  Fourth, in case
of complaints about a committee or a consultant or a lawsuit, the question
would arise as to what guidelines or standards the committee or consultant
was presumably abiding by in carrying out the assignment in the first
place.  The Baby K case (VA) and the Gilgunn case (MA) each involved
dynamics influenced by actions taken by an ethics committee or a
consultant.  A federal judge was critical of an ethics committee in the
former case for attempting to override Baby K's mother's position.  More
consensus within the clinical ethics community about what counts for a
good performance in ethics consultation could not only help prevent
"ethics disasters" but help to defend committees and consultants who were
working within acceptable limits.

 For these reasons, the VBN approved a set of guidelines in 1995 for
consideration by its member institutions.  The guidelines pertain to 1)
the procedure and process of ethics  committees in providing their
services, 2) the education and training of new and continuing members for
these tasks, and 3) the requirements for the educators of ethics
committees.  The requirements for education and training of those who
provide ethics consultation are considerably higher than for those who
engage in the other other services.  Twenty  four hospitals in Virginia
are now in the process of debating and adopting these guidelines at the
board level.  The guidelines are available at the VBN homepage at the
following address: http://www.med.virginia.edu/ed-programs/gpo/ethics.

 In my view, the VBN's experience is relevant to the Task Force's
mission, because what the VBN explored and decided for one state is  what
the Task Force must now consider and recommend in a national context.  The
VBN's consensus development process revealed the need to strive for more
professionalism and quality in providing ethics committees' services.
Striving for more professionalism does not equate with creating a new
profession of clinical ethics, especially when 95% of those who provide
services do so as volunteers who want to engage in clinical ethics because
of their interests in the field. Achieving consensus about guidelines was
not difficult.  The more difficult task is providing the structure and
process on a statewide basis for education and training of a) ethics
committee members, b)  resource persons for ethics committees, and c)
clinicians and others  who desire to devote part of their careers to
clinical ethics.  The  greatest single need in the nation is for regional
education and  training programs to meet the needs of these three groups. 

 I can envision a future approach to accrediting regional or statewide
training and education programs for those who want to study and be
supervised to provide ethics consultation in health care.  The
professional societies need to come to consensus on the educational
standards and supervisory processes for such programs.  The Task Force, in
my view, would do well to concentrate on this task.  Credentialing persons
who do consultation should reside in the local institution itself and be a
part of the institution's practice of appointing its clinical staffs.
This combination of accrediting programs and local credentialing would go
a long way towards raising standards in ethics consultation and the other
services of clinical ethics.


POINTS OF SUBSTANCE AND PROCESS

There was, of course, a great deal of discussion which ensued following
each presentation and during the scheduled discussion session on Sunday
morning.  The following mark some of the major points of substance and
process that resulted from the members' discussions. 

Substance:

1.  There are some central roles or work performed in ethics consultation
and it is part of the mission of the TF to identify what those central
roles or work are or should be.  The second meeting will focus on the core
functions of an ethics consultation(what it is and how it differs from
other types of consultation [e.g., traditional medical or legal
consultation, etc.] and professional activity [e.g., risk management,
patient advocacy, etc.]). 

2.  The great diversity of backgrounds among those who participate in
ethics consultation (it is a multi-professional discipline) is a strength
of the discipline that ought to be preserved.

3.  There is an important difference between a consultant and a
consultation.  The former refers to a person (or persons) while the latter
refers to an activity or process.  The TF may need to look both at (1) the
core features of ethics consultation (e.g. what makes it different from
legal, psychiatric, medical, etc. consultation) and its role within the
institutional setting, and, (2) the central roles that ought to be
performed by the ethics  consultant(s) (the "ethics" person) both within a
particular case consultation and beyond individual case consultation (e.g.
possibly to include education, research, policy formation, etc.).

4.  Regarding the latter it is important to distinguish among those who
participate in ethics consultation in different degrees.  For example,
there may be important differences between (1) those health care workers
who occasionally participate in ethics consultation in their capacity as
health care professionals (simply occasionally being part of an ethics
consult), (2) those who sit on ethics committees, and (3) those who are
full-time ethicists in health care settings. The roles played by (or which
ought to be played by) each, even within the context of "ethics
consultation", might be importantly different.

5.  The work of the TF will be very pragmatic or practical in nature. This
work is motivated, in part, by the realization that ethics consultation is
actually affecting clinical practice and patient care in a variety of
settings.  Because of this, issues of regulation and administration,
accountability (legal and moral), and competence have emerged.  One of the
motivations of the TF must be the issue of quality assurance with respect
to the activity of ethics consultation and with respect to the levels of
competence of those who engage in ethics consultation to varying degrees.
Some recent legal cases which have emerged involving some who identify
themselves as ethics consultants and engage in ethics consultation make
the practical need for this TF even more pressing.

6.  Though various TF members bring to the project differing views on
matters that will be considered in the work of the TF (see Dr. Youngner's
"Central Questions Which the TF Should Consider") no assumptions are being
made by the group at the outset as to what the group's position on any of
these matters must ultimately be.

Process:

1.  What will count as a "consensus" sufficient to result in a TF
recommendation will be left open at the outset to be gradually worked out
throughout the project.  What will count as a "consensus" may vary
depending on the significance of the question being asked and its
importance to the project.

2.  The work of the TF will be released in a concise white paper, series
of journal articles, and an edited book. 

3.  TF members will be free to write dissenting views to be included in
the products of the TF.

4.  TF members should discuss TF proceedings with their various colleagues
and constituencies so as to facilitate input from a large community of
critics and commentators. 

5.  TF members when giving papers or presentations specifically on the
work of the TF should inform TF co-directors, Drs. Youngner and Arnold,
and executive director, Dr. Aulisio. 

6.  Any unpublished work presented at TF meetings may not be used or cited
without the author's permission.

7.  Minutes of each TF meeting will be sent out to all TF members. These
minutes will include abstracts of papers or presentations and a summary of
points of discussion.

8.  SHHV and SBC will be kept apprised of TF work on a regular basis.

9.  A periodic newsletter will be sent out to all TF members.

10.  A posting will be made to MCW following each meeting which will
include a list of TF members and updates on its work.

11.  All TF correspondence should go through the executive director, Dr.
Mark Aulisio, unless it is directed specifically to a particular TF
member.

12.  Because of his background and research interests, the executive
director, Dr. Mark Aulisio, in addition to serving as project coordinator,
will be an active participant in the substance of the TF project.


Task Force Members

Co-Directors:

Robert Arnold, MD
Director, Clinical Ethics Training Program
Associate Professor, Division of General Internal Medicine, Montefiore
Hospital
Suite W-919 Pittsburgh, PA  15213
(412)692-4810,    FAX - 412-692-4892
bma@med.pitt.edu,  bob@ethics.med.pitt.edu

Stuart Youngner, MD
Professor of Medicine, Psychiatry & Biomedical Ethics, Case Western
Reserve University
Director, Clinical Ethics Program, University Hospitals of Cleveland
11100 Euclid Avenue, Cleveland, OH  44106
(216)844-3429 (Jan - 5515), FAX -(216)844-3313
sxy2@po.cwru.edu




Executive Director:

Mark Aulisio, PhD
Research Associate, School of Medicine, Visiting Associate, Center for
Medical Ethics
University of Pittsburgh, MUH, Suite E-916, Pittsburgh, PA  15213
(412)692-4864 (63), FAX -(412)692-4892
aulisio@novell2.dept-med.pitt.edu

Members:

Francoise Baylis, PhD
Bioethics Education and Research,  Dalhousie University
Room C-5 CRC,   5849 University Ave.
Halifax, Nova Scotia,  CANADA  B3H 4H7

Charles Bosk PhD
Department of Sociology,  Center for Bioethics
University of Pennsylvania,  McNeill Building
Philidelphia, PA  19014

Dan Brock, PhD
Professor, Philosophy and Biomedical Ethics
Director,  Center for Biomedical Ethics,  Brown University
Department of Philosophy,  54 College Street
Providence, RI  02902

Howard Brody, MD, PhD
Professor, Family Practice and Philosophy,   Director, Center for Ethics
and Humanities
Michigan State University,  Department of Family Medicine
B-100 Clinical Court, East Lansing, MI  48824

Linda Emanuel, MD
American Medical Association
515 N State St,  Chicago IL 60610

Arlene Fink PhD
Professor of Medicine and Public Health,  Arlene Fink Associates
1562 Casale Road,  Pacific Palisade CA 90272

John Fletcher, PhD
Kornfeld Professor of Biomedical Ethics
Center for Biomedical Ethics, Director,  University of Virginia
School of Medicine,  Box 348
Charlottesville, VA  22908

Jacqueline J. Glover, Ph.D.
Associate Director,  Center for Health Ethics and Law
Robert C. Byrd Health Sciences Center of West Virginia University
1354 Health Sciences North,  PO Box  9022
Morgantown, WV  26506-9022

George Kanoti, STD
Chairman, Department of Bioethics, Cleveland Clinic Foundation
9500 Euclid Avenue, Cleveland, OH  44195-5185

Steven Miles, MD
Associate Professor , Department of Medicine
Associate Professor, Center for Biomedical Ethics
University of Minnesota,  2221 University Ave
SE Suite 110,  Minneapolis, MN  55414


Kathryn Moseley, MD
Senior Staff Pediatrician and Director of Biomedical Ethics
Henry Ford Health Science Center,  CFP -203
2799 West Grand Blvd., Detroit, MI  48202-2689


William Nelson, PhD
Ethics Education Coordinator,  VA National Center for  Clinical Ethics
VAMC, 423 East 23rd Street, New York, NY  10010

Ruth Purtilo, PhD
Director of Center of Clinical Ethicis, Creighton University
2500 California Avenue,  Omaha, NE  68178

Cindy Rushton, DNSC, RN
Assistant Professor, The Johns Hopkins University School of Nursing
Member, Ethics Advisory Group, American Association of Critical Care
Nurses
Home address:
2312 Henslowe Drive
Potomac,  MD  20854

Paul Schyve, MD
Senior Vice President, JCAHO, One Renaissance Blvd.
Oakbrook Terrace, IL  60181

Melanie Wilson Silver
Director, Patient Relations, Shore Memorial Hospital
1 East New York Avenue, Somers Point, NJ  08244-2387

Joy Skeel, M.DIV, BSN
Director, Program in Medical Humanities, Medical College of Ohio
Departments of Psychiartry,  PO Box 10008
3000 Arlington Ave, Toledo, OH  43699

William Winslade, PhD, JD
James Wade Rockwell Professor of Philosophy of Medicine
The Institute for the Medical Humanities, University of Texas Medical
Branch
Galveston, TX  77555-1311


The TF is generously supported by the Greenwall Foundation and numerous
academic and community bioethics centers.