INSTITUTIONAL ETHICS COMMITTEES
Mary C. Howell
Wherever ethical dilemmas of caretaking arise, an Institutional Ethics Committee can help clarify ethical principles and issues and inform the decisions that must be made. Although Institutional Ethics Committees are ordinarily committees of hospitals, any residential institution where people who are dependent are cared for, and where numbers and disciplinary orientations of staff members (or consultant members) are broad enough to provide depth and variety of perspective, could consider the establishment of such a standing committee.
The notion of the Institutional Ethics Committee, or IEC, first came to prominence as a consequence of three landmark events in the late 1970s and early 1980s. In 1976, in the case of Karen Ann Quinlan (whose parents wished that she be disconnected from a mechanical respirator, as she was diagnosed as being in an "irreversible coma"), the Supreme Court of New Jersey recommended that a family should be able to consult an "ethics committee" in order to make this sort of decision. 1 In 1983, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, in the document "Deciding to Forego Life-Sustaining Treatment," recommended that appropriate procedures be used for decision-making, that ethics committees might improve decision-making, and that the courts should be involved only as a last resort. 2 Also in 1983, the federal Department of Health and Human Services promulgated the so-called Baby Doe regulations, which encourage but do not mandate that hospitals caring for newborns establish infant care review committees, analogues of what we call IECs. 3
The functions of the generic IEC are to develop policies and guidelines for limitations of treatment; to monitor problematic cases by record review; to review specific cases in progress; to enhance patient (and family) competence by education; to provide for designation of