In the case of informed consent, familiarity with fundamental bioethical principles as well as accepted legal doctrine will enable the committee to deal with a wide range of clinical and policy matters. A working knowledge of "End-of-Life" decision making permits the committee to offer sound advice to clinicians who are themselves very uneasy about such matters. Hydration/Nutrition issues could be seen as just one specific application of more general principles, but has taken on greater significance in New York State since the Proxy Law went into effect.
"Medical Futility," "Brain Death," and "Cultural/Religious Issues" provide examples of how general principles can spawn specific issues of major importance. It has long been recognized that shared medical decision making draws on the technical expertise of the physician, as well as the value judgments of the patient. The debates about medical futility and brain death are essentially focused on the question about decisions which are alleged to be totally medical/technical in nature. There is no obligation to provide medical treatment which is clearly incapable of providing any benefit. Similarly, the determination of death brings the therapeutic relationship to an end because there is no longer a living patient to treat. While all may agree on those general principles, there is certainly disagreement about their implementation. Families and health care providers often disagree about what kind of response constitutes a "benefit." Likewise, there are those in society who differ with the "whole brain standard" for determination of death.
On the other side of the equation is the patientís value judgment. Established religious or cultural institutions form the backdrop for an individualís decisions. From that perspective, positions held by the health care institution may be contested at a fundamental level. Not surprisingly, some of the very same issues that physicians claim are medical, are argued to be personal and spiritual by patients and families. Faith despite overwhelming odds is seen as the response to claims of medical futility. A different cultural standard for determining death is seen as obstructing the accepted legal standards. Ethics committees must be conversant in such matters in order to resolve conflicts and to educate those who are frustrated by such disagreements.