Considerations in establishing an ethics committee.

As patient advocates, nurses are in an excellent position to stimulate development of ethics committees and to participate actively on committees to assure a forum for reasoned discussion of issues where important values are often at stake. Ethical issues in patient care are not going to go away and are receiving more attention with increased competition and cost containment. While it is a generally accepted principle that cost should never be the sole determinant of patient care decisions, this is occurring where decisions have been made without discussing the ethical aspects of cut-back policy decisions. Institutional ethics committees have the potential for protecting patients' interests and welfare and assuring that reasoned, fair decisions are made for those unable to decide for themselves. Such institutional mechanisms may prevent government intrusion in patient care decisions and assure that recourse to courts is a last resort. Nurses play an important role in helping to develop and evaluate the effectiveness of institutional ethics committees.