Hospital ethics committees (HECs) have historically been instituted "top-down", often ignoring the needs of the professionals and patients who might use their services. Seventy-four physicians and 123 nurses participated in a hospital-wide needs assessment designed to [1] identify their perceptions of the functions of the HEC, [2] determine which services and educational programs were most desired, and [3] explore which forums were most preferred for discussion of ethical problems. Results indicated that utilization of the HEC focused around five areas of concern: withdrawing/withholding treatment, rationing and control of health care, children's rights, role of the patient and family in decisionmaking, and disagreements about treatment. Physicians and nurses differed widely in their attitudes.
Perceptions about the appropriate functions of the HEC strongly influenced decisions regarding which HEC services to use. Needs assessment can play an important role in developing HEC goals and designing programs that meet the needs of professionals. BACKGROUND Dramatic changes in health care during the past 20 years have forced medical professionals to recognize the ethical aspects of problems that historically seemed to be solely medical in nature. Striving for consensus on bioethical issues, such as the use and abuse of new technologies, increased costs, the aging population, cultural emphases on individual rights, uncertain or conflicting social values, and changing relationships between health care professionals, requires health care providers and patients to work together as never before.