ABSTRACT
Over a quarter of a century has passed since health care ethics committees
(HCECs) in the United States received legal recognition as alternatives to the courts in resolving conflicts related to patient end-of-life care. By the
mid to late 1980s HCECs had been established in over half of U.S. hospi-
tals and had received a certain legitimacy in the health care system. Given
their age and growth one could characterize them developmentally as
emerging from adolescence and establishing themselves in young adult-
hood. As a result, we might expect that they would have resolved the
identity crisis characterizing the adolescent years. Yet, HCECs in the
United States remain somewhat amorphous. In part, this may be due to their relative lack of legal status. In most U.S. jurisdictions HCECs remain
unregulated and lack homogeneity in structure and operation. To the extent
that they share common characteristics, these committees are multi-
disciplinary in membership and exist to address ethical dilemmas that occur
within health care institutions. Early on in the evolution of HCECs, judges,
in several judicial opinions, encouraged the development of these commit-
tees, and two states adopted statutes or regulations that provided them with
legal status. Until recently, however, HCECs in most states have been able to develop in a variety of ways and perform a range of functions with lim-
ited legal authority or oversight. In the last few years, a handful of states
have passed laws giving HCECs legal authority to make certain kinds of
decisions. While these states remain in the minority, HCECs in most states
serve a role as a mechanism for ‘‘alternative’’ dispute resolution, particu-
larly in cases involving end-of-life care. This chapter reviews both the his-
tory of HCECs in the United States and their legal evolution.
