Academic journal article The Hastings Center Report

Making Policy by Committee

Academic journal article The Hastings Center Report

Making Policy by Committee

Article excerpt

Making Policy by Committee

Are ethics committees well-suited to devising policies? Thomas Murray has doubts. [1] As an example of problems committees are likely to face in developing policies, he cites the efforts of one committee to deal with refusal of blood transfusions by patients who are Jehovah's Witnesses. [2]

To the contrary, I contend that ethics committees hold out the best hope of keeping ethics in the forefront of hospital policies with moral implications. The difficulties that emerged in the effort noted by Murray to develop a policy for Jehovah's Witnesses were, I believe, more idiosyncratic than typical.

Murray observes that the experience of my committee "shows that there can be plain agreement on one category of cases, but profound disagreement on a closely related one." That is surely true. But should we conclude that because members of the committee held widely disparate views about patient autonomy, any attempt to devise a policy must therefore be flawed? Murray does not draw that conclusion explicitly, but he voices his concern that ethics committees will have difficulty creating many policies, except on matters where there is already a strong consensus.

What should be the solution where a strong consensus does not exist? Should it be to leave policymaking in such cases to one individual authority who most probably holds a single, consistent view about the matter? That has the virtue of efficiency. But it also carries the distinct danger of a dogmatic imposition of one viewpoint about an issue on which reasonable people disagree, and where society as a whole remains in conflict.

The idiosyncracy in the difficulties encountered by my committee lay in the fact that the policy had to address the problem of treatment refusals by pregnant women, which touches issues about which our society is deeply divided. …

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