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In 1983, The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research urged greater use of medical ethics committees. The Commission suggested that these committees could not only review treatment decisions made on behalf of incompetent, terminally ill patients and conduct reviews of those medical decision having ethical implications, but could also provide spiritual, psychological or social counseling for distressed family members. They could, furthermore, serve as prognosis committees endeavoring as such to confirm those prognoses which finds no reasonable possibility of a patient’s return to cognitive state. Today, more and more, ethics committees throughout the country reflect the vision that the President’s Commission articulated in 1983.

This Article presents five constructs - with varying ethical levels of constraint and responsibility - for operating institutional ethics committees. Specific analysis is made of the approaches advanced by an early pioneer in the field - the late Dr. John C. Fletcher, Director of the Center for Biomedical Ethics and Humanities at the University of Virginia School of Medicine - for strengthening, structurally, the focus and the practical work of clinical ethics. By incorporating specific ethics consultative services into the over all foundational structure of ethics committees, the contemporary purpose and mission of these committees become complimentary to the very goal of palliative care at the end of life - namely, assuring humane, efficacious medical assistance.



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