HECs, also IECs) emerged in response to a number of seemingly unrelated concerns. Among these were advances in medical technology, a corresponding increase in opportunities for legal liability, and a concern to control situations laden with liability, such as those arising out of "Baby Doe" Regulations (1, pp. 5-9). The precarious nature of health care ethics today reflects a system which, paraphrasing E.D. Pellegrino, M.D., is "means rich, but goals poor. ~ HECs have been established nationally with the primary goal of serving patients and protecting their interests and well-being. This goal has been pursued primarily through policy formulation, education, case review, and individual consultation. Committees have not been entirely congruent in all aspects of their structure, composition, and philosophy. Some committees adopt a direct decision-making modus operandi, while others merely make recommendations, and still others attempt to arrive at consensus. Committees, bioethicists, and others with committee expertise have been unable to agree on the role of hospital attorneys, risk managers, and other institutional advocates on HECs. The literature to date reflects this ambivalence, with proponents on both sides of this issue stating their case and citing examples to support their position.
Before considering this issue in depth, one might ask why anyone should have a role on a HEC. The discussion that follows is based on the commonly accepted model that HECs are designed to" 183