PDF1 - University of Maryland School of Law

COMMITTEE RESPONSIBILITIES VARYThe HHS model guidelines suggest three major functions forhospital ICRCS: (1) to offer counsel and review inindividual cases, (2) to recommend institutional policies andguidelines, and (3) to educate hospital personnel andfamilies. The committees in our cample vary, both ip theextent to which they perform these functions and in theimportance attached to then.1. Reviewing Individual CasesProspective cast review is don* by all committeesvisited, and is considered their most important function.Committee recommendations on individual cases areadvisory only, rather than binding on the involvedparties. Committee ©embers pointed out that differencesof opinion between treating physicians, parents and thecommittee can usually be resolved through an informaldiscussion process, it this is not possible, thehospital refers the case to CPS for investigation andpossible legal action.One committee indicated that it also reviews selectedcases retrospectively, and a second plans to start soon.Several committees mentioned that patient deaths arereviewed retrospectively by other committees as part ofthe hospital's ongoing quality assurance process.2. Recommending Institutional PoliciesAll committees visited recognized that the development ofinstitutional policies, ranging from the types of caseswhich should be considered by the committee to guidelinesfor addressing particular types of cases, as anappropriate function for the ethics committee. Theextent to which such policies have actually beendeveloped varies from hospital to hospital. While mostcommittees have adopted at least rudimentary writtenpolicies, two committees indicated that they are justbeginning to address their policy developmentresponsibilities.Several respondents noted that the ethics of medicaltreatment decisions is constantly being rethought,reviewed and revised. This is due in part to continuingadvances in medical technology. We were £&14 by oneneonatologist, for example, that recent advances now.enable 80 percent of infants weighing as little a* tvsipounds ftJt fclrtii to &UX3E£V& 4 This was not possible priorto the early 1980s. Low birth weight infants are oftenborn with severe medical problems, some of which mayresult in permanent disabilities despite vigorous medicalintervention.- 5 -195