The Role and Legal Status of Health Care Ethics Committees in the United States

Abstract

Over a quarter of a century has passed since health care ethics committees(HCECs) in the United States received legal recognition as alternatives to the courts in resolving conflicts related to patient end-of-life care. By themid to late 1980s HCECs had been established in over half of U.S. hospi-tals and had received a certain legitimacy in the health care system. Giventheir age and growth one could characterize them developmentally asemerging from adolescence and establishing themselves in young adult-hood. As a result, we might expect that they would have resolved theidentity crisis characterizing the adolescent years. Yet, HCECs in theUnited States remain somewhat amorphous. In part, this may be due to their relative lack of legal status. In most U.S. jurisdictions HCECs remainunregulated and lack homogeneity in structure and operation. To the extentthat they share common characteristics, these committees are multi-disciplinary in membership and exist to address ethical dilemmas that occurwithin health care institutions. Early on in the evolution of HCECs, judges,in several judicial opinions, encouraged the development of these commit-tees, and two states adopted statutes or regulations that provided them withlegal status. Until recently, however, HCECs in most states have been able to develop in a variety of ways and perform a range of functions with lim-ited legal authority or oversight. In the last few years, a handful of stateshave passed laws giving HCECs legal authority to make certain kinds ofdecisions. While these states remain in the minority, HCECs in most statesserve a role as a mechanism for ‘‘alternative’’ dispute resolution, particu-larly in cases involving end-of-life care. This chapter reviews both the his-tory of HCECs in the United States and their legal evolution.