Professional and Institutional Mechanisms

Professional medical associations and specialty societies have responded individually and cooperatively to social and ethical questions raised by developments in medical technology and medical care. Several of these groups have formed ethics subcommittees or task forces to deal specifically with these questions and, in several cases, to formulate practice guidelines to assist health care providers in rendering appropriate care to their patients. The guidance provided by professional societies is often the best source of up-to-date scientific, legal, and practical information available to practitioners. Organizations like the American Medical Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Thoracic Society, and National Advisory Board on Ethics in Reproduction, along with others, have taken the initiative to understand and advise on the complex issues that confront practitioners every day.

Institutional review boards and hospital ethics committees are institution-based mechanisms for deliberation on ethical issues in biomedical research and health care. IRBs review protocols for research involving human subjects to ensure that the research does not violate ethical standards. HECs exist to ensure that difficult ethical decisions about medical treatment are made in a careful and impartial fashion. By federal law, IRBs must exist in any institution that conducts or funds human subjects research using federal funds; hospital accreditation standards specify that accredited hospitals must have either a formal HEC or some other mechanism for the consideration of ethical issues in the care of patients. As mechanisms for ethical deliberation and decision making at a local level, IRBs and HECs are uniquely positioned to make decisions that are sensitive to local norms and values and to the particular circumstances of individual patients or research subjects.

The Institute of Medicine (IOM) and the Office of Technology Assessment (OTA) have also from time to time engaged in bioethics deliberation. An arm of the National Academy of Sciences (NAS), IOM is a private, nonprofit organization, associated with the government by virtue of the 1863 NAS congressional charter to advise the federal government on matters pertaining to science. OTA is a branch of the U.S. Congress, established to advise congressional committees on technical issues in all areas of science and technology. Both IOM and OTA have issued reports on a variety of ethical issues over the past 20 years, including health care resource allocation, genetic research, life-sustaining technology, and the responsible conduct of research. Both organizations have been sought to advise on complex ethical issues because of their ability to convene well informed and impartial study committees.

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