Academic journal article The Hastings Center Report

Is Case Consultation in Retreat?

Academic journal article The Hastings Center Report

Is Case Consultation in Retreat?

Article excerpt

Is Case Consultation in Retreat?

Institutional ethics committees are growing in numbers and popularity. As they proliferate, some suggest they are backing away from their distinctive function of case consultation. Committee members from around the country tell us that veteran groups are doing few case reviews; young committees are doing none. Yet case consultation was the original task these committees were designed to perform. Their special value was to help decisionmakers resolve ethical differences in individual cases in a constructive, nonadversarial way.

Why is this? One explanation is suggested by Karen Ritchie, who points out that some "optional" committee recommendations are, in effect, mandatory. Physicians are reluctant to have others tell them how to treat a patient and may avoid ethics committee consultations as a consequence.

Another explanation is that institutional administrators and legal counsels are ambivalent about ethics committees. Although they believe that establishing them helps avoid institutional trips to court, they worry that flawed case reviews by committees may actually create such trips. Lawrence Nelson's article brings home the need for ethics committees to educate themselves about legal instruments as one prerequisite to providing satisfactory consultations.

A methodological explanation is that many professionals do not want to receive an answer that may be generalizable. Physicians believe that reviews by ethics committees contradict a basic principle underlying the medical approach to clinical care: every case is different. Ethics committees, to the contrary, assume that there are relevantly similar cases and that the same general ethical principles apply to them. …

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