UB Center for Clinical
Ethics and Humanities in Health Care

Ethics Committee Core Curriculum

Ethics Committee Function and Composition

Jack Freer

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:

Consultants

Advantages:

Direct contact with patients and families is possible.
Consultants are more flexible and efficient than committees.
Consultants may be preferred by physicians.

Disadvantages:

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 moral responsibilities.

Committees

Advantages:

Issues with policy implications are more appropriately handled by committees.
Multidisciplinary participation provides diverse viewpoints and conceptualization of alternatives.
Committees provide a more appropriate forum for ethical reflections.

Disadvantages:

Committees are susceptible to the adverse effects of group dynamics.
The size of the committee may be intimidating to those seeking case review.
Committees may have more political power than is appropriate.

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.

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Last Revised 2/15/97