The Emergence of Institutional Ethics Committees

This article is an adaptation of Cranford R.E. Doudera A.E. , The Emergence of Ethics Committees, in Institutional Ethics Committees and Healthcare Decisionmaking ( Cranford R.E. Doudera A.E. , eds.) (Health Administration Press, Ann Arbor, Mich.) (forthcoming 1984) [hereinafter referred to as IECs and Decisionmaking]. This book is developed from a conference held by the American Society of Law & Medicine in April 1983, which convened a faculty of national distinction from a variety of disciplines to discuss various aspects of ethics committees and to try to develop some consensus on what these committees are and should be. Their papers form the first section of this book. Other sections consist of descriptive summaries of actual committees and model guidelines.

Barber v. Superior Court, 195 Cal. Rptr. 484, 486 (Cal. App. 1983). See also Paris J.J. , The Decision to Withdraw Life-Sustaining Treatment and the Potential Role of an IEC: The Case of People v. Barber and Nejdl, in IECs and Decision-making, supra note 1.

In re Infant Doe, No. GU 8204–00 (Cir. Ct. Monroe County, Ind., April 12, 1982), writ of mandamus dismissed sub nom. Infant Doe v. Baker, No. 482-S-140 (Indiana Supreme Court, May 27, 1982) (case mooted by child's death).

Weber v. Stony Brook Hosp., 52 U.S.L.W. 2267 (N.Y. October 28, 1983); United States v. University Hosp., No. CV83–4818 (E.D. N.Y. November 17, 1983).

Nondiscrimination on the Basis of Handicap; Procedures and Guidelines Relating to Health Care for Handicapped Infants; Final Rule, 49 Fed. Reg. 1622, 1623 (January 16, 1984) (to be codified at 45 C.F.R. §84.55).

49 Fed. Reg. 1623–24.

President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment: Ethical, Medical and Legal Issues in Treatment Decisions (U.S. Gov't Printing Office, Washington, D.C.) (1983) [hereinafter referred to as Deciding to Forego Treatment].

Id. at 4.

Id. at 6.

Id.

Id. at 5.

Id. at 161, n.122.

American Medical Association, Comments on Nondiscrimination on the Basis of Handicap; Procedures and Guidelines Relating to Health Care for Handicapped Infants (American Medical Association, Chicago, Ill.) (August 26, 1983) at 17.

In re Quinlan, 355 A.2d 647 (N.J. 1976). See Veatch R.M. , Hospital Ethics Committees: Is There a Role? Hastings Center Report 7(3): 22 (June 1977); Levine C. , Hospital Ethics Committees: A Guarded Prognosis, Hastings Center Report 7(3): 25 (June 1977).

In re Quinlan, supra note 14, at 668, quoting Teel K. , The Physician's Dilemma: A Doctor's View: What the Law Should Be, Baylor Law Review 27: 6, 8–10 (Winter 1975) [hereinafter referred to as Teel].

Teel , supra note 15, at 8.

In re Quinlan, supra note 14, at 671.

Randal J. , Are Ethics Committees Alive and Well? Hastings Center Report 13(6): 10, 10 (December 1983).

Nondiscrimination on the Basis of Handicap; Procedures and Guidelines Relating to Health Care for Handicapped Infants; Final Rule, 49 Fed. Reg. 1621–54 (January 16, 1984) (to be codified at 45 C.F.R. §84.55), amending Proposed Rules, 48 Fed. Reg. 30,846 (July 5, 1983); Interim Final Rule, 48 Fed. Reg. 9,630 (March 7, 1983); Notice to Health Care Providers, 47 Fed. Reg. 26,027 (May 18, 1982). See American Academy of Pediatrics v. Heckler, 561 F. Supp. 395 (D.D.C. 1983).

See U.S. Medicine, p. 3 (November 15, 1983). See also 49 Fed. Reg. 1623–24; Committee on the Legal and Ethical Aspects of Health Care for Children, Comments and Recommendations on the “Infant Doe” Proposed Regulations, Law, Medicine & Health Care 11(5): 203 (October 1983).

Conditions of Participation; Hospitals, 42 C.F.R. §§405.1011–405.1041.

Comments of the American Academy of Pediatrics on Proposed Rules Regarding Nondiscrimination on the Basis of Handicap Relating to Health Care for Handicapped Infants (Pierson, Ball & Dowd, counsel) (September 1983).

49 Fed. Reg. 1622, 1651.

Id. at 1652.

California Medical Association, Guidelines on Hospital Ethics Committees (approved by the California Medical Association Council, October 1, 1983), reprinted in Section III, in IECs and Decisionmaking, supra note 1 [hereinafter referred to as CMA Guidelines].

Id.

AMA Judicial Chairman Sees Emergence of Hospital Ethics Panels as an Inevitability, Federation of American Hospitals Review 16(6): 30 (November/December 1983).

Id.

Youngner S.J. , A National Survey of Ethics Committees, in Deciding to Forego Treatment, supra note 7, at 446.

Id. at 446.

Id. at 445.

Guido D.J. , Hospital Ethics Committees: Potential Mediators for Educational and Policy Change, Dissertation Abstracts International 43(11): (1983).

Kalchbrenner J. Kelly M.J. McCarthy D.G. , Ethics Committees and Ethicists in Catholic Hospitals, Hospital Progress 64(9): 47, 47 (September 1983) [hereinafter referred to as Ethics Committees in Catholic Hospitals].

Id.

Id. at 49, 50.

See Deciding to Forego Treatment, supra note 7, at 160–70.

49 Fed. Reg. 1624.

Id. at 1623.

Lynn J. , The Role and Functions of Institutional Ethics Committees: The President's Commission's View, in IECs and Decisionmaking, supra note 1.

San Francisco Chronicle, February 12, 1983.

For a discussion of the Barber/Nejdl case, see Paris, supra note 2; Barber v. Superior Court, supra note 2.

Capron Alexander M. , Presentation on Brain Death Legislation, at Maintenance of a Cadaver Donor for Multiple Organ Procurement: Workshop under the Auspices of the National Institutes of Health, Arlington, Va. (January 21–22, 1984).

In re Conroy, 457 A.2d 1232, 1233 (N.J. Super. 1983).

Barber v. Superior Court, supra note 2, at 486.

See descriptive summaries, Section II, in IECs and Decisionmaking, supra note 1. See generally Deciding to Forego Treatment, supra note 7, at 160–70 (discussion of various roles and problems).

Veatch R.M. , The Ethics of institutional Ethics Committees, in IECs and Decisionmaking, supra note 1.

Ethics Committees in Catholic Hospitals, supra note 33, at 49.

See Bayley C. Cranford R.E. , Techniques for Committee Self-Education and Institution-Wide Education, in IECs and Decisionmaking, supra note 1.

See descriptive summary, Hennepin County Medical Center ethics committee, Section II, in IECs and Decisionmaking, supra note 1.

Deciding to Forego Treatment, supra note 7, at 5–6.

Ethics Committees in Catholic Hospitals, supra note 33, at 49.

Bedell S.E. , Survival After Cardiopulmonary Resuscitation in the Hospital, New England Journal of Medicine 309(10): 569–76 (September 8, 1983).

Deciding to Forego Treatment, supra note 7, at 164.

CMA Guidelines, supra note 25.

Capron A.M. , Decision Review: A Problematic Task, in IECs and Decisionmaking, supra note 1.

See generally Veatch , supra note 46 (discussion of committees’ moral values).

In re Quinlan , supra note 14, at 671.

See, e.g., Annas G.J. , Reconciling Quinlan and Saikewicz: Decisionmaking for the Terminally Ill Incompetent, American Journal of Law & Medicine 4(4): 367, 378–79 (Winter 1979) (“a more accurate description would be ‘prognosis committee,’ because that is the only issue on which the participants would be asked to consult”). See also McIntyre R. Buchalter D. , Prognosis Committees: The New Jersey Experience, in IECs and Decisionmaking, supra note 1.

In re Colyer, 660 P.2d 738 (Wash. 1983).

Id. at 749.

Id. at 751.

New Jersey Guidelines for Health Care Facilities to Implement Procedures Concerning the Care of Comatose, Non-Cognitive Patients (January 27, 1977), reprinted in Section III, in IECs and Decisionmaking, supra note 1.

McIntyre Buchalter , supra note 58.

Affidavit of Brennan Mary K. , Counsel to the New Jersey Hospital Association, In re Conroy, No. A-2483-82-T (N.J. Supreme Court, April 29, 1983).

Id.

See Glantz L.H. , Contrasting Institutional Review Boards with Institutional Ethics Committees, in IECs and Decisionmaking, supra note 1.

Description of Rose Medical Center ethics committee, Section II, in IECs and Decisionmaking, supra note 1.

CMA Guidelines, supra note 25.

Robertson J.A. , Ethics Committees in Hospitals: Alternative Structures and Responsibilities, Quality Review Bulletin 10(1): 6–10 (January 1984).

Id. at 10.

49 Fed. Reg. 1653.

See Section III, in IECs and Decisionmaking, supra note 1.

See U.S. Medicine, p. 3 (November 15, 1983) (American Medical Association argued that ethics committees should “remain a local option and not become a uniform requirement imposed by the federal government or hospital accrediting bodies”).