Ethics Committee Core Curriculum
Ethics Committee Function and Composition
The proliferation of hospital ethics committees in the 1980s
reflected a need on the part of hospitals to establish some mechanism to
deal with those clinical dilemmas and policy issues that revolved around
the appropriate use of medical technology. There is general agreement on
the (usually) three-fold function of such committees: case consultation,
policy recommendation, and education. Institutions vary widely however,
in the way in which they approach these functions. This is sometimes a
result of the individual composition of the committee. Some committees
are heavily represented by hospital administration or hospital counsel,
and maintain a defensive posture for the institution, while others
actively exclude such individuals. Some committees are largely physician
committees and their deliberations represent that perspective. Most
committees however, attempt to establish a broad based, multidisciplinary
approach and also include nurses, social workers, clergy, and academic
ethicists from philosophy or the social sciences.
The most common function of ethics committees is to provide
clinical case consultation. There remains a wide variation in style and
methodology from one committee to another. While it is still common for
full committees to interview patients/families and other parties, smaller
consultation teams or sub-committees are becoming more common. In fact,
the solitary "ethics consultant" model has been used in a number of
institutions with some success. Much has been written about the relative
benefits of the "consultation" vs. the "committee" models. The following
Table from Swenson & Miller (p.695)
summarizes the disadvantages and
advantages of each:
- Direct contact with patients and families is possible.
- Consultants are more flexible and efficient than committees.
- Consultants may be preferred by physicians.
- The consultant model conveys the message that ethical problems should
be referred to an expert.
- Seeking solutions from consultants may allow physicians to defer their
- Issues with policy implications are more appropriately handled by
- Multidisciplinary participation provides diverse viewpoints and
conceptualization of alternatives.
- Committees provide a more appropriate forum for ethical
Regardless of which model is used, an important question remains
about authority and expertise. Moral authority in a committee setting is
often felt to derive from "consensus." This notion is analyzed in great
detail in the 1991 thematic issue of the Journal of Medicine and
Philosophy edited by Veatch and Moreno (v.16; no.4: 1991 Aug). The
authority of an individual consultant is reflected by his or her training
and expertise. These will remain elusive concepts until such time that
there are accreditation organizations to evaluate such individuals.
Professional organizations such as the Society for Bioethics Consultation
will play an important role in the development of such standards.
- Committees are susceptible to the adverse effects of group dynamics.
- The size of the committee may be intimidating to those seeking case
- Committees may have more political power than is appropriate.
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Last Revised 2/15/97