[The clinical ethics committee (CEC) in the area of conflict between hospital certification, moral pragmatics and scientific approach].

During the last decade numerous consultative bodies for bioethical and medical ethical issues have been established. In this study we will introduce the clinical ethics committee (CEC), which can be mainly brought into action for three purposes: discussing moral problems in a hospital's everyday work, developing guidelines for the clinic, and giving further education to the hospital's staff. Starting with the denominational hospitals at the end of the 1990s, CECs have been established in the meantime at a large number of German clinics, often in an interrelation with hospital certification. We will describe the process of establishing a CEC at the university hospital in Mannheim (Baden-Württemberg) and examine its formal structure given by the statutes and the standing orders. An important issue of the CEC's activities consists in individual consultation, for instance concerning withholding or withdrawing life-supporting therapy from comatose patients. First and foremost it has to be clarified whether there is really an ethical problem which cannot be solved by those seeking advice or whether the CEC is just asked a rhetorical question in order to attain allies. In this case disappointment will often be the consequence. The quality of an ethical consultation cannot be treated as equivalent to the correspondence with preconceived moral attitudes. The CEC is not a "moral police" but a multi-professional body, in which scientific medical ethics should play an important but under no circumstances a dominating role. Meaningful criteria and measuring methods to study the effectiveness of clinical ethics committees will have to be evolved and tested in practice as soon as possible.