In 1980, Jimmy Carter established the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research as an effort to study the differences in availability of health services in the United States. In 1983, the Commission issued a report called Securing Access to Health Care, which aimed to provide an ethical framework for the evaluation of health policy in the United States.1 From this initiative, and from examples in other countries, came hospital ethics committees (HECs). These committees, which deal with the moral and ethical aspects of medical practice, were designed originally to provide legal protection for medical personnel and hospitals, but have varying and diverse goals depending on the institution.2 They differ from clinical research review boards, human subjects review committees and institutional review boards (IRBs) in that these other groups evaluate ethics of medical research, while HECs evaluate ethics of medical practice.
According to the American Medical Association (AMA), HECs serve to make recommendations about difficult, life-changing situations in the lives of patients, families, physicians and other health care professionals.3 In addition, many ethics committees facilitate ethics-related education and policy changes within their institutions.3 The AMA holds that HECs should adhere to the following guidelines: serve as advisors and educators rather than decision-makers, respect the rights and privacy of all participants and of committee deliberations, ensure that stakeholders have timely access to services, be structured appropriately to fit the institution and its patients, adopt and adhere to institutional policies and draw on resources of professional organizations.3 Other sources claim that ethics committees should approach ethical dilemmas with both code consistency—i.e., adhering to the rules and guidelines of the committee and hospital—and ethical consistency—i.e., suggesting decisions that are ethically acceptable.4 Clearly, HECs are held to high standards and strict guidelines by the AMA, as well as by individual researchers.
As they perform ethical consultations, develop institutional policy and educate health professionals, HECs face various challenges. For one, they must protect the interests of individual patients and broader institutions while remaining unbiased and independent.5 Also, HECs must convince health professionals to engage patients and their families in ethical decisions, such as engagement of the “do not resuscitate” policy.6 A third barrier for HECs is educating health professions students on the gravity of the decisions they make and the ethical dilemmas they may face throughout their careers.6 HECs may face backlash by students, professionals, patients and institutions for every recommendation they make.
Indeed, controversy exists about the effectiveness of HECs. Some claim that ethics committees undermine the trust established between a patient and a physician, as HECs imply that ethical decisions are too complex for practitioners and must be approached by a group.7 On the other hand, one study found that mental health professionals find HECs useful in dilemmas related to coercion, confidentiality, information and patient autonomy.8 Other health professionals see the value in HECs as means to avoid legal conflicts with patients and families.9 Overall, research on the effectiveness of HECs is lacking, and it remains unclear if HECs lead to better patient care.10,11
In sum, HECs represent the move of the medical community from a scientific approach to a social one.2 HECs, which adhere to policies laid out by national organizations and local institutions, aim to bring objectivity and ethical reasoning to life-changing dilemmas and to educate professionals on ethical decision-making. Future research is needed to understand health professionals’ relationships with HECs and to clarify the usefulness of HECs in improving patient care.
- Bayer R. Ethics, politics, and access to health care: A critical analysis of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Cardozo Law Review. 1984;6(2):303–320.
- Rosner F. Hospital medical ethics committees: A review of their development. JAMA. 1985;253(18):2693–2697.
- American Medical Association. Ethics Committees in Health Care Institutions: Code of Medical Ethics Opinion 10.7. AMA Principles of Medical Ethics: II, IV, VII 2019; https://www.ama-assn.org/delivering-care/ethics/ethics-committees-health-care-institutions.
- Moore A, Donnelly A. The job of ‘ethics committees’. Journal of Medical Ethics. 2018;44(7):481–487.
- Dörries A, Boitte P, Borovecki A, Cobbaut J-P, Reiter-Theil S, Slowther A-M. Institutional Challenges for Clinical Ethics Committees. HEC Forum. 2011;23(3):193.
- Hajibabaee F, Joolaee S, Cheraghi MA, Salari P, Rodney P. Hospital/clinical ethics committees’ notion: An overview. Journal of Medical Ethics and History of Medicine. 2016;9:17.
- Siegler M. Ethics Committees: Decisions by Bureaucracy. The Hastings Center Report. 1986;16(3):22–24.
- Syse I, Førde R, Pedersen R. Clinical ethics committees – also for mental health care? The Norwegian experience. Clinical Ethics. 2016;11(2–3):81–86.
- Marcus BS, Shank G, Carlson JN, Venkat A. Qualitative Analysis of Healthcare Professionals’ Viewpoints on the Role of Ethics Committees and Hospitals in the Resolution of Clinical Ethical Dilemmas. HEC Forum. 2015;27(1):11–34.
- Hem MH, Pedersen R, Norvoll R, Molewijk B. Evaluating clinical ethics support in mental healthcare: A systematic literature review. Nursing Ethics. 2014;22(4):452–466.
- Harari DY, Macauley RC. The Effectiveness of Standardized Patient Simulation in Training Hospital Ethics Committees. The Journal of Clinical Ethics. 2016;27(1):14–20.