Today U.S. hospitals, long-term care and other health care institutions are rapidly continuing to establish ethics committees. Those watching have witnessed a rapid increase in their formation since Stuart Youngner, M.D., et aL reported the results of their national survey in 1983 (while under contract with the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research) (1). By 1983, they concluded that "With no clear mandate from the courts, legislatures, or the Federal government 1% of U.S. hospitals have established ethics committees." Moreover, "none with fewer than 200 beds...have such committees" (1, pp. 448-49).
A year later, Alexander M. Capron, the Executive Director of the President's Commission, called his readers' attention (2) to the Commission's report of October, 1982 --Making Health Care Decisions --in which the Commission pointed out that *The composition and functions of existing ethics committees vary substantially from one institution to another. Not enough experience has accumulated to date to know the appropriate and most effective functions and hence the suitable composition of such committees" (3, p. 187). It was the Commission's view that the determination of the most appropriate composition or membership of HECs could best be determined only after agreement was reached on their proper and most effective functions. One should keep in mind that the political climate in 1982-83 included significant pressure by the Federal government to regulate medical practice, and we might have easily awakened one morning to discover that HECs were now required by all U.S. hospitals if they wanted to continue to receive any form of federal funding.
To some degree federal irritations have been assuaged, and HECs continue to be established on the basis of a review of state and local interests and needs. For example, in 1984, an American Hospital Association Task Force addressed the legal implications of HECs moving from an advisory capacity to decision-making responsibility (4), and recent New York State legislation calls for expanding the decisions of HECs from an advisory capacity to a mandatory role, a rather serious response to the earlier question concerning the need for such committees (5). Indeed, the State of Maryland has, since