Bylaws of the Tri-County Regional Ethics Committee (TREC)
The Ethics Committee is committed to assisting the healthcare community in Camden, Burlington and Gloucester Counties of New Jersey. It will act as an information resource center for addressing the quality of life and quality of care issues. The Committee will provide assistance in making bioethical decisions, consultations in dispute resolution, and educational support to the healthcare community.
The Ethics Committee is an interdisciplinary body representing multiple healthcare facilities. It will include sub-committees consisting of executive chairpersons and members in the area of Membership, Education and Case Consultation. These committees, through their varied membership support and experience, will offer a broad range of perspectives and alternatives to help resolve ethical conflicts. Through educational training and case consultation, the committee will offer case consultation and support to residents and healthcare professionals who are facing ethical dilemmas. The Committee will:
- Provide consultation and support to patients/residents, families and healthcare professionals involving difficult treatment decisions and health care conflicts.
- Provide educational programming for residents, families, healthcare providers and the community.
- Provide access to resource and educational materials.
- Provide continuing educational opportunities to all members.
The fundamental values and principles will include:
Non Malfeasance Compassion
Membership in TREC is open to any individual of a facility that is involved in providing long-term care or placement of individuals, or any associated activity with individuals requiring long-term care, regardless of color, race, sex, age, religious affiliation, or any similar status for which discrimination is prohibited by applicable law. To effect this non-discrimination policy TREC shall adhere to a formal admissions procedure to be established within TREC’s formal bylaws.
Healthcare Provided Membership
These members will be representatives of facilities, including, but not limited to Administrators, Directors of Nursing, Physicians, Social Workers, Nurses, Ancillary Physician Providers, and clergy. The facility itself will be the member, and as such have one vote per facility. As many representatives from each member facility may attend General Membership Meetings and participate in programs and serve on committees. The area of representation will include Camden, Burlington and Gloucester Counties. Those facilities represented by one voting member, or his/her designee, will be expected to attend scheduled meetings.
These members are those with no formal facility representation but have expressed a desire to participate in the bioethical consultative process. These members will have the same privileges and responsibilities as a healthcare provider member.
Each member facility and each individual member will pay yearly dues as determined by the Executive Board. Facility and individual membership will be assessed yearly in September. Payment is to be forwarded and received by the Treasurer within thirty days from receipt of invoice each year.
These members will be those individuals who provide associated support to the Executive Board. Advisory members will not be able to vote.
These members will be those individuals invited by a committee to participate on the committee on a short-term basis. Guest members offer expertise and insight that may have impact on other TREC members. Guest members will not be able to vote.
- The government of TREC shall consist of the Chairperson, Associate Chairperson and Executive Board.
- The Chairperson shall be the Chief Executive Officer of TREC and preside at each regularly scheduled general membership meetings, Executive Board Meetings, and such special meetings as scheduled.
- The Associate Chairperson shall perform the duties and responsibilities of the Chairperson in his/her absence.
- The Executive Board shall consist of the Chairperson, Associate Chairperson, Treasurer, Recording Secretary, and Education, Membership and Case Consultation Committee Chairpersons. The role of the Executive Board shall be to provide guidance, leadership and coordination to the full TREC membership.
- The Executive Board shall serve for a one year term. These one year terms are renewable. Individual committee members may serve for one full year. These one year terms are renewable.
- The officers of TREC shall be determined by the voting members of TREC. The voting of officers shall take place annually at the first scheduled general membership meeting of the calendar year. The nominations of officers will take place at the last annual general membership meeting of the calendar year.
- Election of officers shall be by voting members of TREC and shall be determined by majority vote. Newly elected officers will take office at the first meeting following the election. If any elected office becomes vacant, the Chairperson shall appoint an interim replacement to complete the term of service.
TREC shall have three Standing Committees. They will be:
- Case Consultation
This Committee shall consist of a Chairperson, a Co-Chairperson, and any TREC member who wishes to participate. The role of the Membership Committee will be to monitor the term of service of the executive committees, schedule office elections, maintain a data base of information of facilities and their staff participants, and to actively recruit and welcome new members on an on-going basis.
This Committee shall consist of a Chairperson, a Co-Chairperson, and any TREC member who wishes to participate. The role of the Education Committee will be to plan and present educational materials and programs to the TREC membership, their facility staff, and the community. A calendar of educational programs will be established each year.
Education is essential for an effective ethics committee. As a starting point, the Committee must develop a working knowledge of bioethics. The Committee, in conjunction with Case Consultation, should plan bioethics related in-service education for healthcare professionals within the member facilities and for other interested parties. Suggested topics of education will be provided to all members by this committee in an effort to determine priority topics of interest and knowledge base needs.
This Committee may provide mock and case reviews and coordinate discussion of same at general membership meetings. A variety of case consultation ethical dilemmas will be provided and presented to members by this Committee.
Case Consultation Committee
This Committee will consult and provide support to staff members, residents/patients, and family members. The aim of such consultation is to facilitate sound decision making, particularly when there is disagreement about optimal care or the choices are difficult or controversial and, especially, when these choices include foregoing life-sustaining treatment. The Committee will not assume the role of making decisions, with the exception that it shall advise when a contemplated action is either unethical or inconsistent with the law or public policy.
The Committee should include members in good standing who are trained in ethical principles and methodology. Case Consultation participants should demonstrate a working knowledge of case consultation forms.
The Case Consultation Committee is to encourage, facilitate, and document sound decision making. Sound decision making is evidenced by such generally accepted features as:
- Thorough case information through use of a case consultation tool (form).
- Fair representation and careful exploration of all alternatives.
- Consideration of long-term consequences.
- Provision of support for the decision makers.
- Evidence of freedom from undue coercion for all decision makers.
- Observation of legal constraints and responsiveness to the sensibilities of the community.
With the cooperation of clinical personnel, the Case Consultation Committee will seek to avert crisis situations and urgent choices wherever possible by:
- Early, prospective and anticipatory involvement of the Committee.
- Prompt response time and flexible procedures.
- Determining which kinds of cases call for which kinds of facilitation or monitoring.
The TREC Case Consultation Committee shall convene as needed to afford consultation to residents, family members and staff members.
The person wishing to involve this Committee should contact the facility Administrator or Director of Nursing, who will determine the urgency of the situation and in consultation with the Chairperson, arrange a meeting. The requester may contact directly the Committee Chairperson or Co-Chairperson. The Chairperson or Co-Chairperson is responsible for coordinating the response to the request in a timely fashion.
Case Data Collection
The gathering of pertinent facts can be done outside of the formal consultation process by one individual at the facility through the use of a Case Consultation Request Form. The form will be forwarded to the Case Consultation Committee Chairperson. If needed, a committee member will communicate with the facility representative to aid in completing the Case Consultation Request Form. This Form will include a comprehensive list of questions that should be addressed before or during the consultative process. Although not all of these questions will be relevant in every case, the list can serve as a comprehensive check list.
Recommendations and Records
The Ethics Committee shall issue a report of its observations and recommendations in response to every case accepted for consultation. This report shall be attached to the resident’s chart and copies kept by the Administrator in confidential files.
Formal recommendations from the Consultation Committee shall be limited to matters of the decision making process.
The Administrator (or his/her designee) shall keep a record of all requests for Committee consultations and copies of the Case Consultation Summary Report. The report shall include the name of those in attendance and the principle observations and recommendations of the Committee.
All Executive Board Meetings shall be recorded and transcribed by the Recording Secretary. Minutes shall be available to all Committee members on or by the next regularly scheduled committee meeting. A master committee book shall be maintained by the Recording Secretary and brought to each meeting for reference. The minutes shall include the names of those in attendance, the facts or agenda items discussed, and relevant discussion and recommendations of the Committee.
All Committee minutes and records shall remain confidential. Information presented in case reviews shall remain confidential and shall be released only to involved parties at the discretion of the Chairperson or his/her designee. Any committee member found to be in violation of this policy of confidentiality shall immediately be removed from the Committee by either the Chairperson or a majority vote of the members present at a regularly scheduled meeting. Such members shall not be eligible to serve again.
These Bylaws may be amended upon written presentation of any proposed amendment being submitted to the Chairperson, read at a regularly scheduled general membership meeting, posted in the monthly minutes and voted upon at the next scheduled general membership meeting by the voting members. An amendment must receive a majority vote for adoption.
These Bylaws and all case review deliberations shall not be misconstrued as directives for action and are not binding to the involved parties. They shall take effect immediately upon acceptance by TREC.