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Who will guard the guardians?

Who Will Guard the Guardians?

Socrates, in Plato's Republic, declares that no one need be appointed to check the decisions of the guardians, for they will have such a passion for knowledge and understanding that they will necessarily realize the Good. Surely members of ethics committees share a similar passion. While our authors below do not insist that specific legislative or executive guardians are required to oversee ethics committees, they suggest that if these committees are to serve as their own guardians, they should fevelop more explicit accounts of several aspects of their case review function.

Bruce Jennings deals with the preliminary--but basic--question of whose conception of the Good is to prevail in ethics committee reviews of surrogate decisions. In such instances, committees have no objective standard of the Good against which to test the surrogate's conception. Moreover, the radical self-emptying demanded of the surrogate may be impossible to achieve. Jennings, consequently, recommends a new approach to assessing surrogate decisions that takes account of the surrogate's concrete situation.

When patients' case are discussed without their participation and consent, Robert Veatch argues, the principle of confidentiality, basic to our shared conception of the Good, is violated. He proposes that disclosure of confidential patient information be allowed only when there is public due process and accountability. Although external guardians of ethics committees are not absolutely essential, publicly accepted standards should be in place requiring ethics committees to give a rational account of their decisions, particularly as these relate to confidentiality.

Ethics committees have no common understanding of their distinctive case review function, according to Judith Wilson Ross, Reviews, therefore, may seem unsatisfactory to those who request them and come to meetings with models of what they expect to occur that differ from those used by the committee. Ross recommends that ethics committees develop a coherent account of the purposes of case review before their current models harden into unchangeable patterns.

A major implication of these recommendations is that ethics committees are now sufficiently mature that they can cogently explain in some detail the substantive and procedural framework within which they carry out case reviews. This is recognized in Maryland's law requiring ethics committees in hospitals explained by Senator Hollinger in the "Legal Note." While none of our authors questions the dedication of ethics committees to the Platonic search for the Good, they maintain that these committees can do more to make this search open to rational account and common understandings.
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Title Annotation:Ethics Committees
Author:Cohen, Cynthia B.
Publication:The Hastings Center Report
Date:Jan 1, 1989
Previous Article:The impact of DRGs on health care workers and their clients.
Next Article:The limits of moral objectivity.

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