Ethics committees and decisions to limit care. The experience at the Massachusetts General Hospital

Decisions to limit care for terminally ill patients present a number of ethical and legal issues. For the past 13 years, the Optimum Care Committee (OCC) of the Massachusetts General Hospital, Boston, has provided advice for physicians faced with such issues. I have reviewed the experience of the committee with the 73 cases on which it provided consultation from 1974 through 1986. In addition, I have compared these cases with those of all 113 patients at the Massachusetts General Hospital who were accorded do-not-resuscitate status without OCC input during a three-month period and found that the two groups differed significantly on a number of clinical variables. I have also found that the OCC cases fall into six categories, each of which presents different ethical and legal issues. In addition, the use of the OCC within the hospital is increasing especially with regard to certain categories of cases. The committee has dealt with controversial issues in a consistent and ethically forthright manner, but legal and moral questions remain. More discussion of the role of ethics committees in withdrawal-of-care cases is needed.