Any belief that HECs and networks could initiate effective regional, state, and national health policies to prevent recurring bioethical dilemmas must rest on at least two important assumptions. First, that some uniformity exists in the roles and constitutions of these committees; second, that bioethical dilemmas currently treated by HECs could be eliminated or solved more easily by additional health policies. In what follows I will attempt to argue why both of these assumptions should be rejected.
In order for HECs to initiate health policies that extend beyond the boundaries of the institutions they serve, we must assume some welldefined mutual ground in the roles, structure, goals, and procedures of the many HECs currently functioning. In reality, there is no uniform role that HECs take on themselves; among the many roles we find education, development of policy and guidelines, case reviews, consultations, and even the improvement of the institution's public relations (1). Some committees may intentionally avoid preparing a clear statement of roles or objectives (2, p. 276). Some HECs have an official status in the institution with well established procedures, while others operate with the approval of the healthcare institution but with no official standing. The composition of the HEC will be determined to a large extent by its purpose. Most HECs for example, are an arm of either the administrative staff or the medical staff. Great variations exist in the selection process and qualifications of members. Some HECs have community representatives while others do not. Some HECs issue binding recommendations following case reviews and consultations, including perhaps a written report to be placed in the patient's record; others communicate only with the physician or the family; and others view themselves only as a sounding board for patients, family