**3. Results and discussion**

Zurzycka et al. [2], in their work, analyzed the information available on the WEBSITE of accredited hospitals in Poland. From 227 hospitals, only 56 confirmed having an HCEC. Most of them expressed how they could request their services and their functions. Raoofi et al. [11] interviewed 19 members of Iran's hospital HCECs about the main challenges they have faced in their roles; the most common barriers to the proper functioning of the committees were lack of support from the authorities, lack of knowledge in Bioethics, and poor communication.

An important characteristic of the CEA is its multidisciplinary composition. Jansen et al. [15] in Australia, when analyzing a hospital committee for 24 months, found that it was made up of various professionals in different areas, mostly physicians (45% of the total). Carrillo et al. [9] found that in Colombia, CEASs were composed of both professionals and representatives of civil society. Zurzycka et al. [2], when reviewing the websites of hospitals with accredited CEAs in Poland, found that no hospital specified who the committee members were. Scherer et al. [12], when interviewing members of a CEA and physicians in a hospital in Germany, found the need for more staff to achieve a multidisciplinary approach, such as nurses or psychologists.

Baker et al. [8], by exposing a series of cases in an emergency room in the United States, which generated critical ethical dilemmas, emphasize the need for these

### *Analysis and Reflections on the Current Situation of the Health Care Ethics Committees (HCECs) DOI: http://dx.doi.org/10.5772/intechopen.112339*

services to have a trained person in Bioethics or a member of an HCEC who can be consulted through digital media, for a better approach to this type of situation. In Germany, Scherer et al. [12] interviewed 28 people among HCECs and healthcare personnel members on the main challenges of the proper functioning of the committees. Lack of communication and hierarchical asymmetry were identified as situations that hinder the work of these bodies.

Głusiec [18], in Poland, investigated the frequency of priests' participation in ethical dilemmas that the HCEC must resolve. The few requests were surprising, considering that it is a Catholic country. The main topics on which the help was requested were the limitation of therapeutic effort and termination of pregnancy. Something that should be mentioned is that most of the priests consulted acknowledged not having adequate knowledge of these issues, so the support of doctors was required for a better understanding. Crico et al. [3], in a systematic review, identified that both physicians and members of HCECs considered the presence of these organizations in hospitals practical since less satisfaction was identified among physicians concerning the service offered by the HCECs, possibly due to their critical stance toward the decisions adopted by the committees.

Gradinarova and Zlatanova [14] compared the level of knowledge about HCECs, among doctors and patients in Bulgaria. The vast majority of physicians and patients were unaware of the existence of these organisms. Those who knew about the HCECs reported that hospitals lacked more information about their functions. Jansen et al. [15] evaluated the role of HCEC in the pediatric area of a hospital in Australia. There was great satisfaction with the role played; the pediatricians who came to this body mostly expressed that this organization was beneficial and would recommend it to their colleagues.

Moodley et al. [19] analyzed the reality of HCECs in African countries, interviewing 20 physicians and bioethicists. These organisms were found to be nonexistent; there was a greater need for ethical consultation during the pandemic and, therefore, the need for HCECs. As for the level of knowledge, this was very low. Pons Valls et al. [20] investigated the level of expertise about HCECs in a hospital in Spain. A high level of knowledge was found about its existence and functions, while the knowledge recorded was low on how to address it. Most recognized that when faced with an ethical dilemma in their work, they would go to these organizations.

Ferreira et al. [13] analyzed the level of development of HCECs in Paraguay. They found that, out of 130 hospitals, only 28 had an ethics committee, and only four identified as HCEC, reflecting the need to boost state policies to promote their further development. Ávila et al. [21], in Mexico, explored the level of knowledge, in traumatology and orthopedics residents, about Bioethics, which turned out to be low, and about HCECs and their functions, which turned out to be in the majority. However, it is surprising that most would never have encountered this body due to an ethical dilemma.

Among the main challenges faced by CEAs in their proper functioning, the work by Raoofi et al. [11] is one of the most comprehensive because it identifies external, internal, and committee factors, especially highlighting the lack of management support as an impediment to achieving real impact. Scherer et a. [12] describe lack of communication and hierarchical asymmetry as the main challenges to committee functioning. Moodley et al. [18] cite a lack of knowledge and resources as challenges to achieving functional CEAs. Galván et al. [17] state that the bureaucracy of the committee impedes good work, which Carrillo et al. Pitshelauri [1] highlights the following factors for the good functioning and development of CEAs: good institutional attitude toward care, professional interests, patient demands, and social development, and a consensus decision-making model based on cooperation and recognition of plurality.

In relation to the topics consulted Zurzycka et al. [2] found that very few committees published this information in Poland, Głusiec [20], when interviewing Catholic priests, found that the main topics consulted to the CEA were on Limitation of Therapeutic Effort (LTE) and contraception. Moodley et al. [18] found that the main topics consulted in Africa were LET, futile treatments, Informed Consent in children, and patient complaints. Carillo et al. [9] found that the main topics consulted were LET, Organ Transplantation, and Brain Death in Colombia. In general, consultations with CEASs are related to conflicts regarding the Start or End of Life, poor doctor–patient relationship, and analysis of the benefit or futility of certain treatments, especially in critical areas.
