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Who Lives, Who Dies?
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11245 |
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Section : |
BOOK WORLD
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| Issue
Date : |
9 / 1993 |
2,336 Words |
| Author
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Stephen G. Post
Stephen G. Post is assistant professor of medical humanities
at the Center for Biomedical Ethics, Case Western Reserve
University School of Medicine, Cleveland, Ohio. |
ENEMIES OF PATIENTS
Ruth Macklin
New York: Oxford University Press, 1993
320 pp., $25.00
FIRST, DO NO HARM
Lisa Belkin
New York: Simon & Schuster, 1993
288 pp., $23.00
Rarely does one find a major American hospital without an ethics committee, usually an interprofessional and interdisciplinary group of a dozen or more individuals. Their function is to develop policies in clinical ethics such as drawing up guidelines on DNR ("do not resuscitate") procedures, to provide the wider hospital community with educational programs on ethical issues in health care, and to serve as consultants to health care professionals and their patients or patients' families regarding difficult treatment decisions. Put the emphasis on consult, because these committees can review cases and make recommendations upon request, but decision-making authority rests with the patient or patient surrogates in conversation with the physician.
Hospital ethics committees are entirely distinct from federally mandated IRBs (Institutional Review Boards) that review all publicly funded research proposals from an ethics perspective to evaluate the process of informed consent, the balance of risks and benefits, and the significance of the research. Ethics committees are primarily a response to a major court case in the mid-70s involving the removal of respirator support from a young comatose woman in New Jersey whose name, Karen Ann Quinlan, is now known to many. Although estimates vary, it is likely that ethics committees exist in about three-fourths of U.S. hospitals.
Risk managers
One of the leading bioethicists in the United States is Ruth Macklin, who began her work in philosophy and ethics two decades ago at Case Western Reserve University and is now professor of bioethics at Albert Einstein College of Medicine in New York City. Her recent book, Enemies of Patients, provides an utterly persuasive criticism of the ways in which ethics committees and medical decision making have been hampered by new bureaucrats--hospital risk managers--attentive only to unfounded and ignorant fears of potential liability rather than to good ethics and the welfare of patients.
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