Ethics committees: time to experiment with standards.

Ethics committees now exist in most hospitals. Their recent establishment in many institutions was a response to a 1991 mandate by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proposed or new legislation in a few states is elevating the status of these committees, either requiring their use in certain cases, allowing them to substitute for judicial review, or granting immunity to those who follow their advice. Despite these recent JCAHO and legislative developments, it is widely recognized that there is a significant lack of data on the effectiveness of these committees and that committee members often lack the requisite education and skills for effective participation in case consultation. We argue that before granting ethics committees additional authority, there is a need for more research on their performance and a period of experimentation with quality standards governing their membership and operations.