Abstract: When It's Not Really Optional Most ethics committees follow what has come to be known as the optional/optional model in reviewing cases. [1] That is, the committee is not required to review a case, and its recommendation need not be followed by the attending physician. Questions are being raised, however, about whether an ethics committee recommendation is truly optional. [2] The institutional force of some recommendations is so strong that they are, in effect, mandatory. There is a range of optionality among ethics committee recommendations, from truly optional to nearly mandatory. There are several reasons for this variation. Many see the case review function of an ethics committee as a form of consultation, and believe that committee conclusions should have the same optional standing as the recommendation of a medical consultant. Yet there is an important difference between the two. The course recommendered by a medical consultant can be set aside by an attending physician who does not wish to follow it; he or she will feel free to justify this decision in the progress notes. That approach is also available for an ethics committee recommendation--at least in theory. The problem is that many attending physicians are unfamiliar with the language and concepts of ethics and, consequently, may find it difficult to provide counterarguments to a committee's conclusion. This, by default, gives the committee's recommendation more weight than is warranted. Not all committees that consult on cases come to a formal conclusion. Some try to ensure that major ethical questions are raised, but do not conclude their discussion by endorsing a particular approach. Such deliberations can nonetheless carry considerable weight. If, as often happens, one point of view predominates, the attending physician may feel pressured to follow it. And in those committees that do come to formal conclusions, whether by taking a vote or by consensus, a unanimous decision may be interpreted by the attending physician as nearly mandatory. The composition of the committee can also affect how its opinions are perceived. Initially, ethics committees tended to be informal groups composed of people in the institution interested in ethics. Today's ethics committees are more likely to be deliberately balance in composition and to have official status within the institution. As a result, they often command greater notice and their recommendations may be seen as more binding. The status of the individual who brings a case to the committee will also affect the optionality of its recommendation. A house officer who brings a case may feel more obliged to follow committee opinion than would an attending physician. …
Publication Year: 1988
Publication Date: 1988-08-01
Language: en
Type: article
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