Ethics committees and due process.

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I have three points to make about due process and an IEC's responsibility to provide ethics consultation on request: 1) the problem of due process needs to be put into the context of ethics consultation, for which committees are responsible but which they are ill-equipped to deliver as a whole group, except in certain circumstances; 2) IECs that attempt to provide consultation without an early stage of bedside consultation, involving the key decision-makers and especially the patient, attending physician and nurse(s), are inviting due process problems as well as a general "failure to thrive"; and 3) due process issues are important to resolve at two levels: a) initial contacts with patient, family and other decision-makers at an early stage of consultation close to the bedside, and b) especially at a second level of conflict resolution, when part or all of the IEC may be involved, because no resolution of the ethical problem(s) has been found at the primary level of consultation and the level of conflict will probably be higher. I propose a two-stage or two-step model for due process issues, i.e., obligations exist at both levels to respect the patient's rights and his or her priority in the decision-making process. My recommendation will be that IECs and their consultants need to be especially meticulous in carrying out these obligations at a second level of conflict resolution, when all or part of the IEC will be involved.