Ethicists and Ethics Committees: As Police, Judges or What?

Hospital ethics committees have been around now for over 30 years and are currently required for hospitals to be formally accredited in the United States. Their responsibility was to provide some judgment regarding ethical dilemmas that were developing over the recent decades primarily in view of society’s acceptance of patient autonomy and the availability of more and more treatments for the chronically and terminally ill and development of life support systems. Also the courts added to dilemmas by allowing withholding life supportive treatment or terminating life support at the request of the patient or patient’s surrogate. Meanwhile, there have been no standards of uniform practice established for hospital ethics committees. In addition, the title of “ethicist” can be used by virtually anyone since there is no school entrance requirements,no academic program that would lead to an ethicist title, no accreditation process for the school and no certification process for the individual to demonstrate the skill and knowledge to be an ethicist. Finally, if that isn’t enough, there is no formal professional organization of medical ethics to set ethical standards which ethicists should follow. In view of all this vacuum, hospital ethics committees and ethicists continue to do a job of consultations requested by physicians, patients, families and hospital staff… but however they do it and whatever they decide, how much significance should be given to their consultations and how much clout should a consultation carry? Here are some questions one can ask regarding the power of an ethicist or the hospital ethics committee.

Should medical ethicists be considered “ethics police” or “ethics judges”? Should members of an ethics committee of a hospital wander around the hospital looking into charts and trying to find either unethical behavior of the hospital staff in their relationship to patients or trying to find potential ethical conflicts before they flare up into a major conflict? In other words, should ethics committees become pro-active rather than retro-active after a conflict or issue has already developed and the committee is called upon for help by patient, family or hospital staff? If an individual is found behaving unethically, should the ethics committee confront that individual and propose change or threaten consequences if the unethical behavior is not terminated? If an ethical issue is found, should it be the hospital ethics committee who decides on the appropriate “ethical” response and will expect it to be carried out? In these instances, the ethics committee members could be looked upon as either “ethics police” or “ethics judges”.

As a member of society, what do you think should be the responsibilities and power of ethicists and hospital ethics committees? ..Maurice