Ethics committees at small hospitals confront most of the same ethical dilemmas present at large hospitals, but must usually deal with them with fewer resources and less access to recognized expertise. Nonetheless small hospital committees can function effectively in the areas of education, policy deliberation, and case consultation. The development of ethics committees at two small Vermont hospitals is described, noting some of the problems associated with smallness and making suggestions about how to surmount them.

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PubMed1988

Grassroots grappling: ethics committees at rural hospitals.

Institutional ethics committees are a well-established mechanism for dealing with ethical dilemmas at large health-care institutions. The presence of these committees at small rural hospitals is a recent phenomenon. Because such hospitals are nonspecialized and isolated and have limited resources, they do not naturally encourage the development and growth of ethics committees. The experience of larger institutions with such committees is not readily adaptable, and role models are lacking. The experience of rural Vermont hospitals with ethics committees shows that these committees can function fully at small hospitals and have three stages of development. To accelerate the evolution of ethics committees at small rural hospitals, networking between these hospitals and an association with academic centers are needed. State medical societies can also support these committees by endorsing and sharing resources.

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