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

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 the mid to late 1980s HCECs had been established in over half of U.S. hospitals and had received a certain legitimacy in the health care system. Given their age and growth one could characterize them developmentally as emerging from adolescence and establishing themselves in young adult-hood. As a result, we might expect that they would have resolved the identify crisis characterizing the adolescent years. Yet, HCECs in the United States remain somewhat amorphous. In part, this may be due to their relative lack of legal status. In most U.S. jurisdictions HCECs remain unregulated and lack homogeneity in structure and operation. To the extent that they share common characteristics, these committees are multi-disciplinary in membership and exist to address ethical dilemmas that occur within health care institutions. Early on in the evolution of HCEDs, judges, in several judicial opinions, encouraged the development of these committees, and two states adopted statutes or regulations that provided them with legal 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 limited legal authority or oversight. In the last few years, a handful of states have passed laws giving HCECs legal authority to make certain kinds of decisions. While these states remain in the minority, HCECs in most states serve a role as a mechanism for “alternative” dispute resolution, particularly in cases involving end-of-life care. This chapter reviews both the history of HCECs in the United States and their legal evolution