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The social transformation of some American ethics committees.

A hospital is not a hotel. The institution must do more than provide rooms in which patients reside and physicians work. It must also take responsibility for who uses its rooms and what goes on within them, a court ruled in the mid-60s [Darling v. Charlatown Community Memnorial Hospital, 33 111. 2d 326, 211 N.E. 2d 253 (1965)]. This decision was part of the challenge to physician control of medical practice that Paul Starr has termed "the social transformation of American medicine." As our authors below indicate, either directly or indirectly, the trend toward institutions'control of health care delivered within their walls is now encompassing ethics committees as well.

The fates of institutional ethics committees and physicians have been closely linked. Each has a primary moral commitment to protect patient well-being. For this reason, ethics committees of the mid-70s were the creatures of physicians who initiated them to gain intra- and interdisciplinary advice about ethical use of innovative technologies for patient care. Changes in the institutional role of physicians, therefore, mean changes in the role of ethics committees.

Medical care in the 80s has increasingly been subjected to the scrutiny of professional managers interested in advancing their institution's share of the market in a highly competitive industry. Ethics committees are also experiencing new pressures to safeguard the institution's financial interests. Some report they have been asked to help meet institutional marketing goals to the detriment of patient care. Others assert that they have been encouraged to gloss over especially difficult cases to avoid expensive legal maneuvers that could work to the institution's disadvantage. The structure of some committees has been designed to protect institutional interests: a few are chaired by legal counsel for the institution; others are composed almost entirely of members of the board who "have an interest in ethics."

This emerging trend has by no means enveloped all ethics committees. The older ones with a respected track record, interdisciplinary representation, and established modes of procedure tend to be less vulnerable to pressures to safeguard the institution at the expense of their distinctive ethical mission. And many administrators and in-house counsel reveal deep commitment to the charge given them in Darling to ensure that good quality care is delivered within the walls of their institution. Our authors approach this looming problem from different angles, but suggest in combination that while ethics committees must be accountable to the institution within which they function, they must also be guaranteed freedom to pursue their distinctive moral goals without fear of being taken over by the institution.
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Author:Cohen, Cynthia B.
Publication:The Hastings Center Report
Date:Sep 1, 1989
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