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The adolescence of ethics committees.

Ethics committees, which were born some ten to fifteen years ago, are now entering their adolescence. And they are engaging in some of the tentative exploration typical of that stage of growth. They know what they are expected to do-case consultation, policy development, and education-but wonder whether they should explore new issues and activities that could challenge them and prod them to redefine themselves.

Whether ethics committees should assist in efforts to protect the financial welfare of health care institutions by giving them an ethical cast is one such intriguing issue. Dan Brock, in an innovative piece below, suggests that such involvement would be consistent with the goal of enhancing patient care, but would also threaten the integrity and independence of ethics committees.

New areas of exploration are also opened in Alan Fleischman's case report and the Mitchell-Swartz legal commentary. Should an infant ethics committee recommend that a parental decision for the continuation of life support for their child be overridden? Do lawyer-members help or hinder ethics committees; Such questions push ethics committees to define their role more carefully and to circumscribe limits of their responsibilities.

As ethics committees move toward adulthood, they will increasingly confront the issue of how their work should be evaluated. These committees have largely been borne along by bursts of enthusiasm from their participants. Yet there is no scientifically validated evidence of their efficacy. How should they determine which things they do well-and which they don't? This is an especially difficult question that committees need the maturity of adulthood to answer. Yet it is no longer possible to design a study to evaluate their work- At this point in the history of medical ethics, we cannot go back and develop a prospective, randomized investigation that would measure the outcome of ethics committee deliberations. It would be considered unethical to treat one cohort of patients in the "old fashioned" way, making life-and-death decisions according to no societally accepted guidelines, while another had access to ethics committee policies, educational forums, and consultative services.

Moreover, the ethics committee notion has become a juggernaut, driven by social, legal, medical, and nursing forces, that can no longer be stopped. Any other factor that so affected decision-making in health care would be subject to more careful scrutiny and analysis. But ethics committees today may well be considered "privileged" from such investigation.

Still, we would not ask whether ethics committees should confront cost containment decisions if we did not believe that they are generally performing their other tasks well. We would not consider how an ethics committee should assess the best interests of an infant if we did not think that such committees provide a valuable forum for exploring such issues. Nor would we question whether lawyers should serve on ethics committees if we were not concerned about whether such service could hamper an effective instrument for evaluating ethical decisionmaking. This "Ethics Committee" section supports the perception that ethics committees are providing a significant service, even as it raises new issues for these groups to consider as they move toward adulthood.
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Title Annotation:health care institutions
Author:Cohen, Cynthia B.
Publication:The Hastings Center Report
Date:Mar 1, 1990
Previous Article:The ethics of home care: autonomy and accommodation.
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