Where are the ethics in ethics committees

Where Are the Ethics in Ethics Committees? Where are the ethics in ethics committees? Even a little reflection on the notion of "ethics" committees, or a cursory experience with their deliberations, suggests that the answer to that question is neither trivial nor obvious. Conflict is the essential element in issues brought before ethics committees. At times, they are asked to advise or comment on specific cases, before or after the fact. At other times they attempt to devise policies for their institutions. I believe that a careful look at ethics committees shows that they are more likely to be successful dealing with cases than with policies--with one broad exception. Defending this claim requires an account of how we make good moral decisions; I can only outline such an account here. To understand what happens in ethics committees, a rich description of a committee at work would be helpful; fortunately, Ruth Macklin has narrated one such effort--to devise a policy for dealing with transfusion refusals by Jehovah's Witnesses. [1] It is a useful text for understanding the limits and possibilities for "ethics" in ethics committees. The experience of Macklin's committee shows that there can be plain agreement on one category of cases, but profound disagreement on a closely related one. When the Witness was a competent adult on whom no other being's survival was inescapably dependent, the committee readily agreed that the person's desire to refuse blood transfusions ought to be respected. They agreed as well that if a child's life or health were severely threatened, the hospital should seek court approval of transfusion. For incompetent adults, the problem was to balance the desire to respect their wishes with potential uncertainties about how to discover their genuine beliefs. On these questions, and the problem of what to do in emergencies, the committee reached substantive agreement relatively quickly. One category of persons, though, uncovered serious conceptual and moral disagreement: pregnant women. When the competent adult Witness who refuses blood is pregnant, we are forced to confront questions about the moral status of the fetus, our obligations (if any) toward that fetus, the relation between moral obligation and public policy, the threat that women may be treated as little more than "reproductive vessels," and a host of other issues. Members of that committee discovered that they held widely disparate views on the meaning and scope of "patient autonomy." What did the committeehs agreement about competent adults signify? Many considerations could have lead individual committee members to support the competent adulths refusal of blood: a commitment to autonomy as a vital moral principle; a religiously based belief in the sacredness and inviolability of the embodies individual; a conviction that forced bodily intrusions by the state would create grave political consequences; or respect for a legal tradition that attaches great importance to religious liberty. Each of these reasons supports a policy of respecting competent, adult Witnesses' decisions to refuse blood. For this category of persons, the several reasons are mutually supportive--but not identical. With a slight change in circumstances--say that the competent adult were twenty-eight weeks pregnant--they could as easily take us down divergent paths. It would be a terrible mistake--a pleasant delusion--to think that, because we can agree on some particular policy issue, we also agree on the precise moral justification for the policy. Stephen Toulmin, describing his experience with the National Commission, observed that as long as the Commissioners stuck to cases, moving from the simpler to the more difficult, they could usually agree. Even when they disagreed, they agreed on the substance of their disagreement. But when they tried to say what principles they were employing, shared language and intelligibility vanished. …