Each of these questions is worthy of study, and should provide valuable insight into the future direction of IECs.

NOTES

1.  

Some discussions of the development of IECs find important parallels to institutional review boards (IRBs) governing biomedical research with human subjects and/or Seattle's dialysis allocation committee of the 1960s. Like the IRB, hospital ethics committees are intended to safeguard patients' interests and right to informed consent; like Seattle's ''God Committee," IECs may deliberate on the appropriate use of advanced life-sustaining treatment. However, neither of these bodies is truly similar to the IEC. Its mandate has been much broader than that of the other structures, and was derived primarily from the need to define whether and how to end treatment that physicians might construe as being in the patient's interests.

2.  

For simplicity, all such institutional structures and processes will be referred to here as IECs.

3.  

Clinical ethics has developed as a field in Canada in parallel with the United States; although under somewhat different guidelines, IECs serve much the same purposes there as here.

4.  

In a some instances, however, patients and families will not seek transfer and doctors do not seek to remove themselves from the patient's case. Although this phenomenon has not been explored, it appears to be more common in community hospitals and where the physician and patient have had a long-term relationship. For patients, families, and doctors faced with a life-threatening situation, conflict in a familiar relationship may be preferable to the anxiety and unknown outcome of change.

REFERENCES

1. Catholic Health Association of Canada. Medico-Moral Guide. Ottawa, ON: CHAC, 1971.

2. Teel, K. "The physician's dilemma: A doctor's view: What the law should be." Baylor Law Review, 1975, 27, 6, 8-9.

3. In re Quinlan, 70 N.J. 10, 355 A. 2d 647, cert. denied, 429 U.S. 922 (1976).

4. New Jersey Health Department. "Guidelines for health care facilities to implement procedures concerning care of comatose, non-cognitive patients," 1976. Cited in E.J. Leadem, "Guidelines for health care facilities to implement procedures concerning care of comatose, non-cognitive patients - A perspective," Hospital Progress, 1977, 58 (March), 9-10.

5. Levine, C. "Hospital ethics committees: A guarded prognosis." Hastings Center Report, 1977, 7 (June), 25-27.

6. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions. Washington, DC: U.S. Government Printing Office, 1983.

7. "Nondiscrimination on the basis of handicap: Procedures and guidelines relating to health care for handicapped infants." Federal Register, Jan. 12, 1984, 49, 1622-1654.

8. American Academy of Pediatrics, Infant Bioethics Taskforce and Consultants. "Guidelines for infant bioethics committees." Pediatrics, 1984, 74, 306-310.

9. United States v. University Hospital, 729 F. 2d 144 (CA2) (1984), and Bowen v. American Hospital Association et al., 476 U.S. Supreme Court 610 (1986).

10. Child Abuse Prevention and Treatment Act, 42 U.S.C., Section 5101-05 (1984).



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