Third, many institutional ethics committees offer ethics consultations, prospectively or retrospectively, on difficult clinical cases, often those involving the withholding or withdrawal of life-support measures. This last function ethics consultation, especially for ongoing cases—has been the main focus of discussion in the bioethics literature. Seven issues have dominated these discussions: questions of competence and authority; impact on the doctor-patient relationship; access to consultation; recordkeeping and charting; problems of evaluation; unsettled legal questions; and questions about the purpose or purposes of consultations.
COMPETENCE AND AUTHORITY. Some committees that offer consultation services, generally smaller committees,
consult as a committee of the whole. Larger committees typically have a subcommittee that consults prospectively
and reports to the committee as a whole for retrospective review of its work. Some committees offer consultation
through a single hoodia diet pills consultant who may be on the committee or have a formal relationship with it. Some critics
have expressed concern that when committees consult, difficult ethical choices will be affected by compromise,
hospital politics, professional rivalries, and conformism(Wikler). Concerns about competence have been raised
when individuals provide consultations. Clinicians typically have few of the skills of trained ethicists and vice versa.
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COMPETENCE AND AUTHORITY
Saturday, February 20th, 2010INSTITUTIONAL ETHICS COMMITTEES
Friday, January 29th, 2010Ethics committees have played clinically relevant roles in U.S. healthcare contexts since the 1960s. At that time, some
hospitals established committees to approve requests for abortion and sterilization and to allocate scarce dialysis
machines. Universities and hospitals created human subjects committees to scrutinize research protocols and consent
forms; in the 1970s, these committees became federally mandated institutional review boards (IRBs).
In the 1976 Quinlan case, in which parents won the authority to remove a ventilator from an incompetent adult
child, the New Jersey Supreme Court recommended that hospitals establish ethics committees to confirm prognoses
in cases involving withdrawal of life support. The 1982 “Baby Doe” ruling that allowed parents to withhold a lifesaving operation from an infant with Down syndrome led to the establishment of infant-care review committees in cases
of withholding or withdrawing life support from disabled newborns. In 1983, a report from the U.S. President’s
Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research encouraged the
formation of hospital hoodia gordoni ethics committees to review cases that raised ethical dilemmas and to resolve ethical conflict.
Baby Doe
Tuesday, January 5th, 2010In its 1976 Quinlan decision, the New Jersey Supreme Court tentatively suggested the use of ethics committees to assist persons who faced difficult end-of-life decisions. In the early 1980s, the federal “Baby Doe” regulations spurred hospitals to develop internal mechanisms for dealing with decision making for severely handicapped infants.
In 1983 the U.S. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research endorsed the notion of shared decision making between patients and physicians. It suggested consultation with an ethics committee as a possible means for resolving disputes that arose in the clinical setting, but noted that the efficacy of such consultation had not been demonstrated (U.S. President’s Commission).
In 1985 the National Institutes of Health and the University of California at San Francisco cosponsored a conference in Bethesda, Maryland, for persons designated by their institutions as ethics consultants. The conference was attended by fifty-three invitees, and fifty additional persons expressed interest in attending a future meeting of this group (Fletcher, 1986). By 1987 the Society for Bioethics Consultation was formed for the support and continuing education of clinical ethics consultants.
In 1992 the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) published a requirement for healthcare institution accreditation that all healthcare institutions must have in place a mechanism for resolving disputes concerning end-of-life decisions.