Abstract

KIE: In Siegler's opinion, institutional ethics committees (IECs) threaten to undermine the physician patient relationship by removing or attenuating the physician's decision making authority. Though a majority of committees do not view themselves as final decision makers but as advisors or consensus developers, a physician who goes against committee advice is bucking considerable social pressure. Ethics committees should not consult on cases or even review decisions already made, but should develop and coordinate staff training programs to educate personnel to make decisions in their own areas of expertise. In place of IECs, there should be small advisory groups in particular specialty areas such as burn units, medical oncology services, neurosurgical or neonatal units, emergency rooms, or transplantation services.