Healthcare ethics consultation has been developed, practiced, and analyzed internationally. However, only a few professional standards have evolved globally in this field that would be comparable to standards in other areas of healthcare. This article cannot compensate for this situation. It contributes to the ongoing debate on professionalization by presenting experiences with ethics consultation in Austria, though. After exploring its contexts and providing an overview of one of its primary ethics programs, the article analyzes the (...) underlying assumptions of “ethics consultation” as an essential effort on the path to professionalize ethics consultation. (shrink)

Background:This article combines foundational and empirical aspects of healthcare education and develops a framework for teaching ethical theories inspired by pragmatist learning theory and recent work on the concept of moral resilience. It describes an exemplary implementation and presents data from student evaluation.Objectives:After a pilot implementation in a regular ethics module, the feasibility and acceptance of the novel framework by students were evaluated.Research design:In addition to the regular online module evaluation, specific questions referring to the teaching of ethical (...) theories were added using simple (yes/no) and Likert rating answer formats.Participants and research context:At the Bern University of Applied Sciences, a total of 93 students from 2 parallel sub-cohorts of the bachelor’s program in nursing science were sent the online survey link after having been exposed to the same modular contents. A total of 62% of all students participated in the survey.Ethical considerations:The survey was voluntary and anonymous. Students were free to write their name and additional comments.Findings:Students consider ethical theories—as taught within the proposed framework—as practically applicable, useful, and transferable into practice.Discussion:Teaching ethical theories within the proposed framework overcomes the shortcomings described by current research. Students do not consider the mutually exclusive character of ethical theories as an insurmountable problem.Conclusion:The proposed framework is likely to promote the effectiveness of healthcare ethics education. Inspired by pragmatist learning theory, it enables students to consider ethical theories as educative playgrounds that help them to “frame” and “name” the ethical issues they encounter in daily practice, which is seen as an expression of moral resilience. Since it does not advocate a single ethical theory, but is open to the diversity of traditions that shape ethical thinking, it promotes a culturally sensitive, ethically reflected healthcare practice. (shrink)

Ellen Fox and collaborators have produced the most detailed description of healthcare ethics practices in the United States available. Some findings are shocking for anyone committed to promoting q...

Healthcare Ethics, Law and Professionalism: Essays on the Works of Alastair V Campbell features 15 original essays on bioethics, and healthcare ethics specifically. The volume is in honour of Professor Alastair V Campbell, who was the founding editor of the internationally-renowned Journal of Medical Ethics, and the founding director of three internationally leading centres in bioethics, in Otago, New Zealand, Bristol, UK, and Singapore. Campbell was trained in theology and philosophy and throughout his career worked (...) with colleagues from various disciplines, including law and various branches of healthcare. The diversity of topics and depth of contributors' insights reflect the breadth and impact of Campbell's philosophical work and policy contributions to healthcare ethics. Throughout his long academic career, Campbell's emphasis on healthcare ethics being practice-oriented, yet driven by critical reflection, has shaped the field in vital ways. The chapters are authored by leading scholars in healthcare ethics and law. Directly engaging with Campbell's work and influence, the essays discuss essential questions in healthcare ethics relating to its methodology and teaching, its intersection with law and policy, medical professionalism, religion, and its translation in different cultural settings. Chapters also grapple with specific enduring topics, such as the doctor-patient relationship, justice in health and biomedical research, and treatment of the human body and the dead. (shrink)

Healthcare ethics consultation is therefore one of the most consequential, institutionally accepted, and widespread forms of public philosophy in the United States. In this chapter, the authors begin with an overview of the development of healthcare ethics and its emergence as a concrete practice embedded in healthcare settings. They then describe the core ethical principles that inform the everyday practice of ethics consultations and the generally accepted steps involved in conducting a consultation. The authors (...) discuss the role of clinical ethicists in medical education and policy development. Finally, they conclude with some remarks on the distinctive contributions made by those with philosophical training to these endeavors and the importance of continued engagement by philosophers in this important public work. (shrink)

This volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organized around the main stages of the clinical encounter from the patient's perspective. They run from staying well and 'first contact' through to either recovery or to long-term illness, death and dying.

In this article, the question is discussed if and how Healthcare Ethics Committees (HECs) should be regulated. The paper consists of two parts. First, authors from eight EC member countries describe the status quo in their respective countries, and give reasons as to the form of regulation they consider most adequate. In the second part, the country reports are analysed. It is suggested that regulation of HECs should be central and weak. Central regulation is argued to be apt (...) to improve HECs’ accountability, relevance and comparability. To facilitate biomedical citizenship and ethical reflection, regulation should at the same time be weak rather than strict. Independence of HECs to deliberate about ethical questions, and to give solicited and unsolicited advice, should be supported and only interfered with by way of exception. One exception is when circumstances become temporary adversarial to ethical deliberation in healthcare institutions. In view of European unification, steps should be taken to develop consistent policies for both Eastern and Western European countries. (shrink)

Shocking. There seems no other response to the Fox findings. The bioethics community has been working for decades to improve the quality of, and access to, competent healthcare ethics consultation....

Tertiary healthcare ethics (HCE) consultation occurs when an HCE consultant at a healthcare facility requests guidance from one or more senior HCE consultants who are not members of that facility’s HCE consultation service. Tertiary HCE consultants provide advanced HCE guidance and/or mentoring to facility (secondary) HCE consultants, mirroring healthcare consultation in clinical practice. In this article, we describe advantages and challenges of providing tertiary HCE consultation through a hub-and-spoke model administered by a national integrated HCE service.

Now in its sixth edition, this highly popular text covers the range of ethical issues affecting nurses and other healthcare professionals. Authors Simon Robinson and Owen Doody take a holistic and practical approach, focused in the dialogue of ethical decision making and how this connects professional, leadership and governance ethics in the modern healthcare environment. This focuses on the responsibility of professionals and leaders, and the importance of shared responsibility in the practice of healthcare. With a (...) foreword by the eminent medical ethicist Alastair Campbell, the revised edition includes contemporary topics, such as the duty of candour, recent cases, such as the Mid Staffs scandal, and ethical perspectives on vulnerable groups, such as; persons with intellectual/learning disability, dementia and those with an enduring mental illness. It builds on professional identity and personal development as part of ongoing learning, individual and organizational, and provides interactive ways that helps the reader to develop reflective ethical practice. This text aims to enable ethical engagement with the ever changing healthcare environment, and is a must-have for anyone serious about ethics in healthcare. Holistic and practice relevant approach New perspectives on vulnerable groups, such as persons with intellectual/learning disability, dementia and those with an enduring mental illness Descriptive as well as normative ethical theory Promoting dialogue and engagement with practice, practitioners, patients and families Development of professional ethical skills Connecting professional ethics to leadership, governance and social ethics Highly accessible format Case studies/Scenarios presented within chapters and pause for thought exercises to promote dialogue and engagement? Suitable for pre/post registration nurses, students, health care professionals. (shrink)

Ethical theories -- Healthcare ethics -- Modern healthcare ethics : landmark events that shaped hospital ethics protocols -- A nurse-led ethics committee -- Common ethical challenges -- Ethics case studies.

The rural health context in the United States presents unique ethical challenges to its approximately 60 million residents, who represent about one quarter of the overall population and are distributed over three-quarters of the country’s land mass. The rural context is not only identified by the small population density and distance to an urban setting but also by a combination of social, religious, geographical, and cultural factors. Living in a rural setting fosters a sense of shared values and beliefs, a (...) strong work ethic, self-reliance, and a tendency for close-knit extended social structures where overlapping relationships are commonplace. (shrink)

Introduction to healthcare ethics committees / D. Micah Hester and Toby Schonfeld -- Brief introduction to ethics and ethical theory / D. Micah Hester and Toby Schonfeld -- Ethics committees and the law / Stephen Latham -- Cultural and ...

BackgroundNo standard method exists to assess how many consults a healthcare ethics consultation (HCEC) service should perform. To address this, we developed a method to estimate the volume of HCEC services based on a mixed-methods approach that included a systematic review and survey data on the volume of consult services requested.MethodsOur investigation included a systematic review of studies that reported the volume of HCEC services that were requested from 2000 to 2017, institutional surveys, and statistical analyses that estimated (...) the volume of HCEC services that were adjusted to the size of the hospitals in the survey and to population acuity.ResultsWe contacted the authors of 19 studies that met our inclusion criteria; 17 authors responded to the institutional survey and five provided annualized data points. We found that standard methods of reporting the volume of HCEC services led to inaccuracies in estimating the growth of HCEC services over time. To rectify this, we proposed two means to estimate volume based on either the service goals of HCEC services or hospital size and acuity.DiscussionThe statistical limitations of our study highlight the need to standardize the sharing and reporting of data in clinical ethics. Future work should further standardize methods of HCEC quality assessment using measures similar to those we describe. (shrink)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a (...) model to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

In recent years, the theoretical work of Gilligan in women's psychological development has led to the development of the concept of moral orientation or moral voice in contrast to the concept of moral reasoning or moral judgment developed by Kohlberg. These concepts have been of particular interest in gender studies, especially as applied to adolescence. These concepts of moral orientation and moral reasoning are being increasingly employed in healthcare ethics studies in a wide variety of settings. The recent (...) work has included studies of physicians, nurses, dentists, veterinarians, social workers, teachers of medical ethics, and hospital ethics committees. However, the study of moral development in healthcare providers has been hampered because collecting the necessary data from healthcare workers has been labor intensive and extremely time consuming. More efficient methods are needed. (shrink)

This anthology includes authors whose original articles appeared in prior issues of HEC Forum, and who have been frequently cited in the principal bioethics journals. It details the necessary ethical considerations for those working in related fields.

Over the past two decades ethics committees have proliferated in healthcare institutions across the country. Catalysts for this growth include the endorsement of ethics committees by the New Jersey Supreme Court in the Quinlan case, by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research in its report entitled Deciding to Forgo Life Sustaining Medical Treatment, by the U.S. Department of Health and Human Services in its 1985 “Baby Doe” regulations, by numerous (...) other courts in treatment decisionmaking opinions issued after Quinlan, and more recently by the Joint Commission on Accreditation of Healthcare Organizations. (shrink)

In this updated second edition, Debating Health Care Ethics explores contemporary moral challenges in health care, providing students with the essential tools to understand and critically evaluate the leading arguments in the field and to develop their own arguments on important moral problems in health care. Written in a clear and concise way, the textbook’s first three chapters explore the nature of arguments and ethical theories, while the remaining chapters introduce students to moral problems in health care through case (...) studies and dramas that feature complex scenarios involving patients, family members, and health care providers. Each case study and drama is followed by a lively debate where the authors defend their unique approaches to the dilemma. This new edition now includes more gender inclusive dramas, an expanded discussion of feminist ethics, a case study on euthanasia that highlights changes to Canadian law, and an update on fetal consciousness that informs the debate on abortion. Emphasizing critical issues in health care from a Canadian perspective, this essential textbook will benefit students in philosophy, nursing, and health studies. (shrink)

One of the challenges of modern healthcare ethics practice is the navigation of boundaries. Practicing healthcare ethicists in the performance of their role must navigate meanings, choices, decisions and actions embedded in complex cultural and social relationships amongst diverse individuals. In light of the evolving state of modern healthcare ethics practice and the recent move toward professionalization via certification, understanding boundary navigation in healthcare ethics practice is critical. Because healthcare ethics is (...) endowed with many boundaries which often delineate concerns about professional expertise and authority, epistemological reflection on the relationship between theory and practice points toward the social context as relevant to the conceptualization of boundaries. The skills of social scientists may prove helpful to provide data and insights into the conceptualization and navigation of clinical ethics qua profession. Empirical ethics research, which combines empirical description (usually social scientific) with normative-ethical analysis and reflection, is a way forward as we engage and reflect upon issues which have implications for practice standards and professionalization of the role. This requires cooperative engagement of the descriptive and normative disciplines to explore our understandings of boundaries in healthcare ethics practice. This will contribute to the ongoing reflection not only as we envision the professional role but to ensure that it is enacted in practice. (shrink)

BackgroundThe impact of healthcare ethics educational interventions on participants’ ethical development is rarely reported on and assessed; even less attention is paid to educational interventions that focus on end-of-life ethical issues.AimTo evaluate the impact of the Ethical Framework for End-of-Life Care Study Sessions Programme ( EOLCSS) on the moral development of healthcare staff who are delivering end-of-life care.MethodsThe EOLCSS was delivered to 20 multi-disciplinary health care staff in Ireland in May 2013. Effect on moral reasoning was measured (...) pre and post education using the Defining Issues Test 2 (DIT2). Inferential statistics were used to examine the relationships between change in DIT2 scores and demographic variables.ResultsParticipants experienced moral reasoning development following receipt of EOLCSS. Age and previous ethics education contributed to the observed changes in moral reasoning.ConclusionsReceipt of the EOLCSS may contribute to moral reasoning development in practicing healthcare professionals. (shrink)

The unique context of the rural setting provides special challenges to furnishing ethical healthcare to its approximately 62 million inhabitants. Although rural communities are widely diverse, most have the following common features: limited economic resources, shared values, reduced health status, limited availability of and accessibility to healthcare services, overlapping professional–patient relationships and care giver stress. These rural features shape common healthcare ethical issues, including threats to confidentiality, boundary issues, professional–patient relationship and allocation of resources. To date, there (...) exists a limited focus on rural healthcare ethics shown by the scarcity of rural healthcare ethics literature, rural ethics committees, rural focused ethics training and research on rural ethics issues. An interdisciplinary group of rural healthcare ethicists with backgrounds in medicine, nursing and philosophy was convened to explore the need for a rural healthcare ethics agenda. At the meeting, the Coalition for Rural Health Care Ethics agreed to a definition of rural healthcare ethics and a broad-ranging rural ethics agenda with the ultimate goal of enhancing the quality of patient care in rural America. The proposed agenda calls for increasing awareness and understanding of rural healthcare ethics through the development of evidence—informed, rural-attuned research, scholarship and education in collaboration with rural healthcare professionals, healthcare institutions and the diverse rural population. (shrink)

Recent global events demonstrate that analytical frameworks to aid professionals in healthcare ethics must consider the pervasive role of social structures in the emergence of bioethical issues. To address this, the authors propose a new sociologically informed approach to healthcare ethics that they term “social bioethics.” Their approach is animated by the interpretive social sciences to highlight how social structures operate vis-à-vis the everyday practices and moral reasoning of individuals, a phenomenon known as social discourse. As (...) an exemplar, the authors use social bioethics to reframe common ethical issues in psychiatric services and discuss potential implications. Lastly, the authors discuss how social bioethics illuminates the ways healthcare ethics consultants in both policy and clinical decision-making participate in and shape broader social, political, and economic systems, which then cyclically informs the design and delivery of healthcare. (shrink)

Volume 20, Issue 3, March 2020, Page 19-21.

Croatia is a transitional society in that it is a country emerging from a socialist command economy toward a market-based economy with ensuing structural changes of a social and political nature—some extending into the healthcare system. A legacy from our past is that, until now, Croatian healthcare institutions have had no real experience with clinical ethics support services. When clinical cases arise presenting complex ethical dilemmas in treatment options, the challenges presented to the medical team are substantial. (...) The case described below recently occurred on a ward in a university hospital in Croatia. An unexpected request from the patient’s parents created a number of issues that needed to be addressed by the medical team, which was made more difficult by the lack of clinical ethics support services. Such cases press the question currently being debated as to what type of ethics support services would be suitable for Croatia and why. (shrink)

Die Wissensvermittlung in Gesundheitsethik ermöglicht es Auszubildenden der Pflege, sich in ihrer zukünftigen Tätigkeit bei Entscheidungsprozessen des Behandlungsteams hinsichtlich pflegeethischer Fragestellungen einzubringen. Vor diesem Hintergrund wurde anhand der vorliegenden Studie die Entwicklung moralischer Positionen sowie pflegeethischer Kenntnisse von Pflegeauszubildenden sichtbar gemacht. An zwei Krankenpflegeschulen (Berlin und Fürth) wurden im Rahmen einer Panelstudie von August 2010 bis März 2011 Daten einer ersten Querschnittserhebung von Auszubildenden in der Pflege erhoben. Für die Studie wurde ein strukturierter Fragebogen verwendet. Die Studienteilnahme erfolgte freiwillig. Alle (...) Auszubildenden hatten vor der Befragung in unterschiedlichem Umfang Unterricht in Gesundheitsethik erhalten. An beiden Standorten zeigten die Teilnehmenden einen Zuwachs an pflegeethischen Kenntnissen. Auszubildende, die bislang keine praktische Erfahrung mit Sterbehilfe gemacht hatten, zeigten Schwierigkeiten in der theoretischen Handhabung dieser Maßnahmen. Für alle Auszubildenden zeigte sich ein allgemeiner Trend zu einer Befürwortung des partizipativen Interaktionsmodells und damit zu einer Förderung der Patientenselbstbestimmung. Zugleich schätzten die Studienteilnehmenden die Fähigkeiten von Patienten, medizinisch richtige Therapieentscheidungen zu treffen, als gering ein. Die Ausbildung in Gesundheitsethik besitzt ein großes Potential, Kenntnisse zu vermitteln und dadurch die ethische Kompetenzentwicklung zu befördern. Unsere Ergebnisse werfen die Frage auf, inwieweit es einer Integration praktischer Erfahrungen mit Fragestellungen der Gesundheitsethik bedarf, um eine praxisrelevante und wissenschaftlich fundierte Wissensvermittlung zu gewährleisten. (shrink)

BackgroundHealthcare ethics is neglected in clinical practice in LMICs such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses in a tertiary teaching hospital in Nepal.MethodsThis was a cross sectional study conducted among resident doctors and ward nurses in the largest tertiary care teaching hospital of Nepal during January- February 2016 with a self-administered questionnaire. A Cramer’s V value (...) was assessed to ascertain the strength of the differences in the variables between doctors and nurses. Association of variables were determined by Chi square and statistical significance was considered if p value was less than 0.05.ResultsOur study demonstrated that a significant proportion of the doctors and nurses were unaware of major documents of healthcare ethics: Hippocratic Oath, Nuremberg code and Helsinki Declaration. A high percentage of respondents said that their major source of information on healthcare ethics were lectures, books, and journals. Attitude of doctors and nurses were significantly different in 9 out of 22 questions pertaining to different aspects of healthcare ethics. More nurses had agreement than doctors on the tested statements pertaining to different aspects of healthcare ethics except for need of integration of medical ethics in ungraduate curricula,paternalistic attitude of doctor was disagreed more by doctors. Notably, only few doctors stood in support of physician-assisted dying.ConclusionsSignificant proportion of doctors and nurses were unaware of three major documents on healthcare ethics which are the core principles in clinical practice. Provided that a high percentage of respondents had motivation for learning medical ethics and asked for inclusion of medical ethics in the curriculum, it is imperative to avail information on medical ethics through subscription of journals and books on ethics in medical libraries in addition to lectures and training at workplace on medical ethics which can significantly improve the current paucity of knowledge on medical ethics. (shrink)

One element of the American Society for Bioethics and Humanities’ recently-piloted quality attestation portfolio for clinical ethics consultants is a “philosophy of clinical ethics consultation statement” describing the candidate’s approach to clinical ethics consultation. To date, these statements have been under-explored in the literature, in contrast to philosophy statements in other fields such as academic teaching. In this article, I argue there is merit in expanding the content of these statements beyond clinical ethics consultation alone to (...) describe the author’s approach to other important “domains” of healthcare ethics practice. I also claim such statements have at least three additional uses outside quality attestation: as a reflective practice learning tool to increase role clarity among practicing healthcare ethicists and bioethics fellows; assisting practicing healthcare ethicists in clarifying role expectations with those they work with; and helping inform developing professional practice standards. (shrink)

This paper considers the utility of Ethnomethodology (EM) for the study of healthcare ethics as part of the empirical turn in Bioethics. I give a brief introduction to EM through its respecification of sociology, the specific view on the social world this generates and EM's posture of ‘indifference’. I then take a number of EM concepts and articulate each in the context of an EM study of healthcare ethics in professional practice. Having given an overview of (...) the relationship and perspective EM might bring to the professional practice of healthcare ethics I consider whether and how such an approach could be deployed. Whilst an ethnographic study might be problematic I suggest a number of alternative methods through which such EM research could be accomplished. I conclude with the suggestion that, as a particular approach to sociological research, EM offers good deal of potential for the empirical study of healthcare ethics in practice which could result in an improved reflexive understanding of professional ethical practices in bioethics. (shrink)

Volume 20, Issue 3, March 2020, Page 1-5.

This issue’s “Legal Briefing” column covers recent legal developments involving institutional healthcare ethics committees. This topic has been the subject of recent articles in JCE. Healthcare ethics committees have also recently been the subject of significant public policy attention. Disturbingly, Bobby Schindler and others have described ethics committees as “death panels.” But most of the recent attention has been positive. Over the past several months, legislatures and courts have expanded the use of ethics committees (...) and clarified their roles concerning both end-of-life treatment and other issues. These developments are usefully grouped into the following eight categories: 1. Existence and availability2. Membership and composition3. Operating procedures4. Advisory roles5. Decision-making and gate-keeping roles6. Confidentiality7. Immunity8. Litigation and court cases. (shrink)

Bioethics, Volume 36, Issue 6, Page 724-727, July 2022.

Finland is a country in Northern Europe with a population of approximately 5.1 million people. It lies between Sweden and Russia and has a border with Norway too. It is part of the European Union and also belongs to the European Monetary Union. It is a welfare state in the sense that healthcare services, schools, universities, and social services are for the most part paid for by tax-based funding. In terms of basic healthcare, the state, through local municipalities, (...) provides comprehensive coverage to all residents, and this is utilized by both the wealthy and the poor. (shrink)

A common financial model used in business decisions is the cost/benefit comparison. The costs of a proposed project are compared with the benefits, and if the benefits outweigh the costs, the project is accepted; if the costs exceed the benefits, the project is rejected. This model is applicable when tangible costs and benefits can be reasonably measured in monetary units. However, it is difficult to consider intangible factors in this model because intangible factors cannot be readily quantified in money.While some (...) might argue that the financial model should not apply to healthcare decisions, the fact is that costs do enter into the picture. People may decide to forego needed healthcare because they cannot afford it. Healthcare providers may make choices based in part on the costs of diagnosis and treatment, rather than solely on medical information and what is best for the patient. Should financial issues enter into healthcare decisions – decisions about human health and well being? If so, how should the costs and benefits be measured and evaluated? What are some ethical issues and dilemmas involved in such decisions? (shrink)

Last year we reported that there are no professorships in medical ethics in Finland. This year we are happy to report that a chair in medical ethics has now been advertised at the University of Turku. We also gave details about the attempts to come up with a law on assisted reproduction. As predicted, there were problems, and eventually the proposal was withdrawn, leaving Finland still without a law on assisted reproduction. The talk on large-scale genetic databases has (...) been surprisingly quiet, and even the report published by the Parliament's working group on this matter, implying that a population database should be created, went virtually unnoticed. In this year's contribution, we address the issues of male circumcision, stem cell research, and, within the field of research ethics, the problem of defining medical research. (shrink)

Responding to a major pandemic and planning for allocation of scarce resources under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of the Maryland (...) Healthcare Ethics Committee Network in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies. (shrink)