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Introduction
Medical centres today face numerous challenges to providing high-quality and patient-centred care, and medical Ethics Programs must evolve to address those challenges proactively. Academic medical centres currently seek to provide care to sicker, older and more diverse patients than ever before, while using the most up-to-date complex technology, training young clinicians and conducting leading research. It is therefore imperative that these institutions create a moral culture in which practitioners of high-quality, cost-effective care can function at their best. To create and maintain a positive moral culture, institutions must rethink the traditional model for medical Ethics Programs, in which ethical issues are considered the designated responsibility of one or a few individuals, rather than as the responsibility of the institution as a whole and of all of the people within it. 1-8 This paper describes an innovative programme at a Harvard-teaching hospital that has had success in addressing these challenges. The Ethics Liaison Program at BIDMC has helped to make ethics part of the culture of our institution, and we feel that other institutions would benefit greatly from the establishment of similar programmes.
BIDMC is a teaching hospital of Harvard Medical School, formed in 1996 as the result of a merge of Beth Israel Hospital and Deaconess Hospital. BIDMC is a tertiary care facility with a level 1 trauma centre and ranks third in the country for National Institutes of Health funding, with 649 licensed beds (including 77 critical care beds and 60 OB/GYN beds). Medical ethics has a long history at BIDMC: Beth Israel Hospital published the first Patient's Bill of Rights in 1972, and a Beth Israel clinician coauthored one of the first three published articles on Orders Not to Resuscitate in 1976. 9 10
Ethics Programs at BIDMC began in 1998, with the establishment of the Ethics Support Service by Lachlan Forrow, director of Ethics Programs, and Stephen O'Neill, clinical ethicist. Stephen O'Neill was promoted to assistant director in 1998, and to associate director in 2005. Wendy McHugh joined the Ethics Support Service as clinical nurse ethicist in 2004, and was promoted to associate director in 2015. The Ethics Advisory Committee, a multidisciplinary body that oversees Ethics Programs at BIDMC, was created in 2003. In 2006, Wendy McHugh became the director of...