As a practicing physician with no prior experience of HECs I came to the HEC Seminar (that convened in Miami, FL) rather like a journalist investigating a political movement. I was impressed by the sheer magnitude of the phenomenon, the more or less simultaneous appearance of HECs more or less everywhere, typically on a voluntary basis and without financial support or official backing. Clearly there was powerful magic at work somewhere within a medical system in critical condition nearly everywhere else.
Even more striking to me was the practical success of many HECs in resolving major ethical dilemmas, in which contradictory viewpoints often seemed equally compelling or equally unacceptable, and despite the fact that they generally lacked the power or authority to enforce their recommendations. This high degree of effectiveness under adverse circumstances likewise seemed to indicate both a powerful need and a reliable mechanism for satisfying it.
Furthermore, the analytic description of what HECs do once they are formed -self-education, policymaking, case review, and consultation -cannot account for the dynamism that elicited them in the first place. Still less can ethical principles themselves account for it. For even when these are familiar and clear enough in the abstract to be generally accepted and agreed upon, their application in specific cases is still likely to be problematic, controversial, and evocative of strong passions on every side.
With these general concerns in mind, I began to wonder if there were not some logically prior or more generic function that underlies whatever these committees do, and that might help us to understand why they are so necessary and so effective. It is certainly true that the development of complex and elaborate biotechnologies has created troubling dilemmas regarding the allocation of scarce resources (e.g., artificial or donor kidneys). It is also true that HECs often succeed in resolving disputes voluntarily because all parties know that unpleasant and expensive litigation will likely follow if they fail.