When values compete: ethics committees and consensus

When conflict arises between physicians's commitments to prolong life and to relieve suffering, health care providers must assess the purpose of medical practice. Concepts that must be clarified and translated into action are "quality of life," "relief of suffering," "inevitable death," and "normal care." A multidisciplinary ethics committee brings together individuals with varied backgrounds: those with philosophic or religious training, physicians, nurses, administrators, attorneys, and others. Consultation among these persons representing the intellectual cultures in the health care structure can benefit the quest for the "right" decision. In a similar way, an ad hoc coalition of representatives from various groups, including The Catholic Health Association, agreed on the language of an amendment to SB 1003, which mandates ethics committees to recommend guidelines for treating handicapped newborns. In addition to examining scientific issues (e.g., brain damage, permanent unconsciousness) and humanistic concerns (e.g., the guidance provided by religious beliefs, incompetent patients), the committee would on occasion sponsor a subcommittee to deal with a specific patient problem in which preservation of privacy precludes large-group discussion. Such a subcommittee could also approach a range of questions beyond the use of life-sustaining treatment, such as consultative practices and physician and hospital fees. To be effective in improving quality and appropriateness of health care, ethics committees must relentlessly deal in a frank manner with the problems of contemporary medical practice. They must not avoid contentious problems or protect hospitals and physicians rather than patients.