Ethics committees as corporate and public policy advocates

Ethics Committees As Corporate and Public Policy Advocates

Should ethics committees engage in public discussion of ethical issues affecting patient care? Is it wise for them to address directors of corporate conglomerates, visit congresspeople, submit briefs to courts on these issues? If so, should they speak out on positions taken at their home institutions or present their own?Pulley-mounted bead chains control the blinds. Closed, the white plastic curtains match the white gypsum board walls adjacent to them.At Smugglers' Notch in northern Vermont, a resort that combines top-of-the-line skiing with New England charm, you'll find the perfect hideaway for the entire family. The resort has 56 trails down three mountains, Morse, Madonna and Sterling, which provide just enough challenge for the intermediate skier. Novices should concentrate on mastering the Morse. After a day on the slopes, treat yourself to a massage or relax in the Scandinavian Spa. The kids will enjoy spending time at the animal petting zoo, riding a pony or hanging out at the video arcade. There's indoor tennis and swimming, sleigh rides and family game nights. The three-day/three-night Mini-Vacation package, which includes resort accommodations, an unlimited lift ticket and daily ski instruction is $235. For reservations, call 800-451-8752.Mature committees have something more effective and valuable than untoward pressure to offer legislators--their experience and knowledge. And they can provide this in ways that are not coercive. They can identify the very existence of an ethical issue in a proposed policy, suggest a variety of moral perspectives on it, assess whether a consensus exists about it in their communities, and provide examples of institutional policies that address it appropriately. They can contribute to the public discussion essential to our system of government by helping ensure that ethical issues affecting patient care are aired fairly and fully.However, if you're not quite as proficient at skiing the powder, don't shy away. Winter in the Sangre de Cristo mountains is like no other. Experience the ambiance of colony rich with Spanish and Native American culture. Call Taos Ski Valley at 800-992-7669, for information.The difficulty with this view is that often there is no bright line between patient care decisions and "broader" policy decisions. A corporate decision to close down an emergency room to avoid treating patients who cannot pay has an adverse impact on patient care. If ethics committees sit by passively and do nothing when such decisions are in the offing, they will abdicate their primary responsibility.Some will argue that this is a terrible mistake. Ethics committees should function as ethical tabula rasas, bringing no preconceptions or biases to their deliberations. Since their members often have different ethical convictions, none has a claim on the absolute truth. The role of these committees, on this view, is to facilitate the development of fair decision-making processes, not to espouse substantive positions. Committees cannot take a stance on policy matters without compromising their integrity as impartial adjudicators and should not become advocates for certain corporate and public policies.Daily lodgings range from $95 to $165 at the cabin or condominium of your choice. Package rates are available including lodging and lift tickets. Call Mammoth Visitor Information, 619-934-2712, for additional lodging information and reservations. Those looking for more challenging mountains, not to mention a little Spanish-style romance, should mosey over to Taos Ski Valley, Taos, N.M. Of the 71 trails over 50% is expert terrain with steepness not often matched in North America.A final objection is that ethics committees that enter the public forum will emerge with "dirty hands." Advocacy has unpleasant connotations of political coercion by pressure groups out to maximize their own interests.Ethics committees are highly vulnerable to institutional pressures--the power that created them can destroy them. Some would argue that in the interests of self-preservation, ethics committees should not become involved in policy advocacy, for this would put them at risk of being viewed as trouble-makers who must be silenced.Photo: With the "curtain" to one side, the study, bedroom, and seating area flow together to form an open master suiteOther object that ethics committees have no business delving into broader issues affecting corporate survival and government allocations. Instead, they should stick to patient care problems within the institution and conform to their mission.While 30 years ago it was uncommon for blacks to be avid skiers, today skiing is a popular form of physical exercise that is also a great way to vacation and socialize. Arthur Clay, co-founder of the NBS and founder of "The Gang" chapter in Chicago, began skiing in 1965. He describes that initial experience as totally immersing himself in a white world. "The snow was white. The people were white. It was extremely rare to see other black faces." As a consequence, Clay says that when blacks did meet on the slopes, they became instant friends--a tradition that continues with the camaraderie found among skiers in the NBS.The midwest is characterized by hills of lower altitude and smaller resorts, but that doesn't mean you can't get in some good skiing. The Upper Peninsula region of Michigan, near the Wisconsin border is "Big Snow Country." It consists of four ski areas: Indianhead, Big Powderhorn, Blackjack and Whitecap and the Porcupine State Park.Sun Valley Resort in Idaho, is known as America's original glamour ski resort. Today, with 17 lifts, 1,300 acres for skiing and lodging for 12,000 in surrounding areas, Sun Valley still provides the foremost in modern skiing in an atmosphere of picturesque beauty. The 56-year-old resort boasts high-speed highways and low-gear bump runs immaculately groomed on the mountains of Dollar and Baldy. Dollar Mountain is noted for its beginner runs, while Baldy is great for intermediate and advanced skiers. A three-day ski-lift pass costs $110 for adults and kids 17 and under ski free most of the season. Call 800-634-3347, for reservations.

Whey ethics committees? Don't we have enough individual ethicists, state commissions, and private groups advocating ethical approaches to patient care? Ethics committees can serve a distinctive function because they are familiar with the wrenching anxieties of making medical choices, the kinds of decisions that patients at their institution tend to make, the roles of health care professionals, and the ways in which institutional infrastructures function. They can offer public and corporate policy makers some sense of the institutional realities at stake when ethical issues affecting patient care arise.

Author: Cynthia B. Cohen