Published online by Cambridge University Press: 29 July 2009
Over the past two decades ethics committees have proliferated in healthcare institutions across the country. Catalysts for this growth include the endorsement of ethics committees by the New Jersey Supreme Court in the Quinlan case, by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical Research (“President's Commission”) in its report entitled Deciding to Forgo Life Sustaining Medical Treatment, by the U.S. Department of Health and Human Services in its 1985 “Baby Doe” regulations, by numerous other courts in treatment decisionmaking opinions issued after Quinlan, and more recently by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
1. In re Quinlan, 355 A.2d 647, cert. denied 429 U.S. 922 (N.J. 1976). In Quinlan, the New Jersey Supreme Court quoted an article by Dr. Karen Teel, which suggested that each hospital establish an “ethics committee composed of physicians, social workers, attorneys and theologians … which [would serve] to review the individual circumstances of ethical dilemma[s] and which [would provide] much in the way of assistance and safeguards for patients and their medical caretakers.“
2. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forgo Life-Sustaining Treatment: A Report on the Ethical, Medical and Legal Issues in Treatment Decisions. Washington, D.C.: U.S. Government Printing Office, 1983.Google Scholar The commission concluded that in order to protect the interests of patients who lack decision-making capacity, healthcare institutions should “explore and evaluate … various administrative arrangements for review and consultation, such as ‘ethics committees,’ particularly for decisions that have life or death consequences …”
3. 45 C.F.R. sec. 1340.15 (1991). These regulations strongly encouraged hospitals caring for infants to establish infant care review committees to review cases involving the withholding of life-sustaining treatment.
4. See, for example, In re Torres, 357 N.W.2d 332 (Minn. 1984), where the Supreme Court of Minnesota stated that an ethics committee's affirmation of a family's decision to withdraw life support from a patient in a persistent vegetative state would eliminate the need for prior court approval.
5. JCAHO accreditation guidelines require institutions to have mechanisms in place to address ethical issues in patient care. See Section RI.1, 1995 Comprehensive Accreditation Manual for Hospitals.