Institutional Ethics Committees

Ethics 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 QQuinlan 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 life-saving 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 ethics committees to review cases that raised ethical dilemmas and to resolve ethical conflict.

By the mid-1980s, a movement had begun to establish institutional ethics committees in healthcare facilities, especially in hospitals. In 1982, only 1 percent of all U.S. hospitals had ethics committees; by 1987, over 60 percent did (Fleetwood et al.). Ethics committees were endorsed in this period by leading professional groups, including the American Medical Association, the American Hospital Association, the American Academy of Pediatrics, and the American Academy of Neurologists. Growth in the number of institutional ethics committees continued into the 1990s and spread to nursing homes and hospices (Glaser). It is likely that the number and influence of these committees will grow as the length of stay in hospitals continues to decline and more patient days are spent outside hospitals. Moreover, with the shift of many kinds of care to alternative sites, it is likely that other institutional ethics committees will develop and spread—in home-healthcare agencies and managed-care networks, for example. Hospital ethics committees remain, however, the most common institutional ethics committees and the most closely analyzed in bioethics literature.

There is a paucity of empirical studies of hospital ethics committees. Committees have a "grass-roots" character, reflecting a variety of local circumstances and personalities. These factors make it hard to generalize. Nevertheless, some typical features have emerged. One of these features is interdisciplinary composition. Generally, committees are composed of doctors, nurses, social workers, pastoral-care professionals, and philosophers or theologians trained in ethics. Committee members can also include administrators, hospital attorneys, and consumer or community representatives. Committees are sometimes authorized by the medical staff; sometimes by the hospital governing board; sometimes by the administration.

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