Ethics committees and case consultation

The nation's experience with “Baby Doe” laws in the 1980s led to a reaction against deciding problematic ethical cases through the courts. Institutional ethics committees established to deal with particular clinical areas such as dialysis allocation or treatment of newborns served as a model for clinical ethics committees, intended to serve as an intermediary between individual physician decisions and extramural judicial interventions in ethically troubling cases. By 1993, the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) began to require all hospitals of more than 200 beds to have ethics committees with responsibility for education, policy formation, and case consultation. No specific procedures are required, but the multidisciplinary committee described in this case has become widely accepted as standard. Not all committees are equally effective within their institutions, and attention to supporting the role and processes of those committees is an important organizational concern.

The Society for Bioethics Consultation (now the American Society of Bioethics and Humanities) has developed guidelines for clinical ethics consultation. They emphasize the importance of working to ensure that all involved parties with a moral stake in the outcome of a given case have a chance to have their voices heard, and recommend documentation of the results of all consults.

Authority and responsibility

The traditional and legal authority of physicians to determine medical care has long been mediated by nurses and other allied health professionals who are given the responsibility of carrying out their decisions.