Hospital Clinical Ethics Committees The Geneva Experience – Switzerland

In hospitals, ethics consultations and committees were a product of the 1970s in the United States of America (US). The US administration encouraged their development particularly when the influential 1983 report of the President’s Commission for the study of Ethical Problems in Medicine and Biomedical and Behavioral Research, entitled Deciding to Forgo Life-Sustaining Treatment, gave a significant support to the role of ethics committees. In the early 1980s, a survey in the US showed that only one percent of the hospitals had at that time a functioning ethics committee, whereas ten years later, in the mid 1990s, an important majority, probably more than ninety percent of the large US hospitals, had created such committees. Since the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated the healthcare institutions to develop these committees in 1991, they seemed to proliferate, and to disseminate also in Europe, with unequal distributions according to different countries. They present different roles and modalities of functioning. Therefore, it is not surprising that disagreement and criticisms exist about their proper role, and about their mode of operation. Some of the disputes that we will consider below are related to theoretical issues. As an example, some ethicists and also care providers argue that ethics committees’ action can be considered as an usurpation of physicians’ authority, and that only clinically competent and skilled professionals should be in a natural position to carry out the role of case consultation. This opinion seems more prevalent among surgeons than among non-surgeons, and within several countries, like in