Hospital Ethics Committees

As the privacy of physicians making decisions about life and death in private with relatives has diminished, public awareness and interest have increased and proposals for regulating decisions about life-sustaining medical care fall into this chapter.

Abstract

THE CUSTOM of physicians making decisions about life and death in private with relatives is becoming an anachronism. While that custom may persist in some hospitals and particularly when patients die at home, such events increasingly occur in referral hospitals,1with the involvement or scrutiny of innumerable consultants, residents, nurses, social workers, students, and other personnel. As the privacy of these decisions has diminished, public awareness and interest have increased. A growing catalogue of controversial court cases,2-7statutes,8and regulations9-11marks the beginning of a search for principles to guide conduct in a way that can attract consensus. These changes have not occurred in a vacuum. They are part of the response to practices that have aroused concern. Laws are generally not written until there is a perception that an important moral principle has been broken. Proposals for regulating decisions about life-sustaining medical care fall into