As hospitals have evolved and become more intricate, the ethical dilemmas they face have also increased in complexity. To address this, many institutions have implemented health care ethics programs (HCEPs) that extend beyond simple ethics consultation services, yet comprehensive research on these programs remains limited. A national, cross-sectional survey targeting a stratified sample of 600 U.S. hospitals was conducted to assess the presence, functions, activities, staffing, workload, funding, and principal challenges of HCEPs.
Out of 372 hospitals with completed surveys, nearly all (97%) reported having an HCEP. While clinical ethics support was nearly universal, other roles were less common: ethical leadership (35.7%), compliance oversight (29.0 percent), business ethics (26.2 percent), and research ethics (12.6 percent). HCEPs provided ongoing ethics education to diverse audiences, including all staff (77.0%), nurses (59.9 percent), attending physicians (49.0%), hospital executives (44.2%), medical trainees (20.3%), and the broader community (18.4%). Staff primarily engaged in reviewing existing policies rather than creating new ones. Ethics representation was present in executive leadership in 80.5 percent of hospitals, with HCEP involvement on other committees in 40.7%, community engagement in 22.6%, and leadership of large ethics quality improvement initiatives in 17.7 percent. Programs at major teaching and urban hospitals were generally more integrated, with broader scopes and more activities. Larger, academically affiliated, and urban hospitals employed more personnel dedicated to HCEP duties, and a greater proportion received financial compensation for this work. Resource limitations were the most frequently reported challenge overall, whereas underutilization was the main concern in hospitals with fewer than 100 beds. Strategies to address these challenges commonly included enhanced staff training and securing additional funding. Although these findings should be interpreted cautiously given the study’s limitations, they offer valuable insight into the characteristics of health care ethics programs (HCEPs) in U.S. hospitals and the factors associated with these features, potentially informing strategies to strengthen such programs.
