Objectives

1. Explain how the understanding and function of ethics committees have developed in the concept of modern healthcare.

2. Deine the relationship between clinical ethics consultation and the ethics committee.

3. Describe the roles, constitution, and authority of ethics committees in institutions.

Case

Isaiah is a 56-year-old construction foreman who arrived by ambulance at University Hospital after falling from a sixth-story scaffolding that had been improperly installed. Emergency surgery stabilized his condition, and he remains in the Surgical Intensive Care Unit (SICU). Three weeks post-surgery he is breathing on his own, but has made little additional neurological progress. The neurosurgery team has given Isaiah a poor prognosis for recovery, and considers further aggressive medical treatment to constitute “futile care.”

Isaiah and his second wife, Shirley, have been married for 2 years. When the treatment team discusses the possibility of transitioning Isaiah to comfort care, Shirley defers decision-making authority to Isaiah’s three adult children: Evan (28), Tamara (23), and Jack (19). Evan and Tamara, while both close to their father, disagree on what they think he would want in this situation: Evan assures the team his dad would not want to live “like a vegetable,” but Tamara insists that her dad views all life as sacred and therefore she wants “everything done.” They both agree that Jack, who lived with their dadmost recently before his deployment to Afghanistan with the US Army, would have the best sense of Isaiah’s wishes, and both of them insist that Jack would agree with each of them.