Role of the ethics committee: helping to address value conflicts or uncertainties

This article addresses two basic questions about ethics committees: why we have them, and how they might be helpful to clinicians. Our answer to the first question is twofold. First, we suggest that legal, regulatory, and professional forces drove the development of ethics committees, particularly as an alternative to litigation. Second, we argue that ethics committees arose in response to a clinical need for a formal mechanism to address some of the value conflicts and uncertainties that arise in contemporary health-care settings. We argue that this need, reflected in early high-profile legal cases, stems partly from the complex value-laden nature of clinical decision making, a pluralistic societal context, a growing recognition of the rights of individuals to live by their values, and the relevance of those values for medical decision making. In answer to the second question, we draw out three ways ethics committees might be helpful to clinicians: education, policy formation or review, and consultation. We devote the majority of our discussion to ethics consultation and its relation to the emerging area of palliative care. In so doing, we highlight three important differences: (1) the scope or range of cases for which they may be appropriate, (2) focus in any particular case, and (3) general orientation-between ethics consultation and palliative care that clinicians should take into account in deciding to seek the assistance of either or both.