Institutional ethics committees (IECs) now exist at many health care facilities and are in the planning stages at others. Due in part to the recent origins of IECs and the continuing debate over their optimal composition, role, and status in health care institutions, legislatures and courts have yet to recognize or clarify their legal status. Neither reported cases nor statutes clearly explain whether the proceedings and records of IECs must be disclosed to prosecuting attorneys or to parties to civil lawsuits, whether such information can be introduced as evidence in a trial, or whether persons serving on IECs or those providing information to IECs may be held civilly or criminally liable for actions by the committees.

This article sets forth some basic principles relating to the composition and functions of IECs, then examines the questions of confidentiality of IEC proceedings and immunity for persons serving on or providing information to the committees. Several reasons against and in favor of confidentiality and immunity are stated.

Circe directed Ulysses to fill the ears of his seamen with wax, so that they should not hear the strain [of the Sirens]; and to cause himself to be bound to the mast, and his people to he strictly enjoined, whatever be might say or do, by no means to release him till they should have passed the Sirens’ island. His men obeyed… . At the sound of the Sirens Ulysses struggled to get loose, and by cries and signs to his people begged to be released; but they, obedient to his previous orders, sprang forward and bound him still faster. They held on their course, and the music grew fainter till it ceased to be heard, when with joy, Ulysses gave his companions the signal to unseal their ears, and they relieved him from his bonds.

Circe directed Ulysses to fill the ears of his seamen with wax, so that they should not hear the strain [of the Sirens]; and to cause himself to be bound to the mast, and his people to he strictly enjoined, whatever be might say or do, by no means to release him till they should have passed the Sirens’ island. His men obeyed… . At the sound of the Sirens Ulysses struggled to get loose, and by cries and signs to his people begged to be released; but they, obedient to his previous orders, sprang forward and bound him still faster. They held on their course, and the music grew fainter till it ceased to be heard, when with joy, Ulysses gave his companions the signal to unseal their ears, and they relieved him from his bonds.

Recent efforts to evaluate the effectiveness of the informed consent process between physician and patient have focused on the ability of patients to understand written “informed consent” documents. Several researchers, employing traditional readability formulas to measure the reading level of such documents, have noted that many of these forms are written at a level too difficult for most people to understand. Readability formulas, such as those of Flesch and Fry, and the SMOG formula, have become convenient measures of the effectiveness of informed consent documents in conveying information to patients to enable them to make decisions about recommended therapies.

Our experience, in a pilot study, with readability formulas to test an informed consent document used in childhood poliomyelitis immunizations led us to conclude that readability formulas are an inadequate measure of patients’ comprehension of written information about medical procedures.

The American health care system is currently engaged in one of the most profound transitions in recent history. Demands for cost containment propel this transition, catalyzed by third party payers—federal and state governments, Blue Cross/Blue Shield, private insurers, third party administrators, and employers. The era of usual and customary compensation for health care providers participating in third party programs may be rapidly ending. Pharmacy witnessed the demise of usual and customary compensation in the early 1960s and has been fighting to regain it since then.

In recent years, third party prescription programs (TPPPs) have been the subject of, or have been affected by, various lawsuits, rulings by the Federal Trade Commission (FTC), and state attorney general opinions. Most have not been favorable for pharmacists. In a previous article in Law, Medicine & Health Care, this author explored some of the litigation and legislation which pharmacists attempted as a means to solve the problems presented by TPPPs.

Criticisms of the impersonal ways in which some physicians relate to their patients, as well as calls for the infusion of more compassion, empathy, and humanity into the delivery of medical care, have abounded in recent months, as physician-watching gains popularity as a major American sport. Various culprits have been ‘indicted” for current shortcomings in the humanistic quality of many physician/patient relationships: the traditional paternalistic orientation of the medical profession, the explosion in the scientific knowledge that physicians are expected to master, the growing importance and effectiveness of medical technology in diagnosing and curing disease, economic pressures, and the ever-present, anxiety-stimulating shadow of medical malpractice. Whatever its specific etiology, the too-prevalent concern for “curing” at the expense of “caring” among modern medical practitioners has been widely lamented in both professional and lay forums.