The document discusses the increasing decision-making power of healthcare committees and the need for regulatory measures to ensure due process. It highlights issues such as potential biases and the expansion of the authority of healthcare ethics committees (HECs) in making critical decisions. The author argues for an evolution in the approach to HEC oversight, moving towards stricter standards to mitigate errors and protect patient rights.

1. The Growing Decision Making Power of Healthcare Committees: Why Regulation Is Needed to Assure Due Process Thaddeus Mason Pope, J.D., Ph.D. Widener University School of Law 6 th Int’l Conf. Clinical Ethics Consultation Portland, Oregon $ May 14, 2010

3. Due Process The price of deference

4. Presume Medical judgment is best Unless Uninformed Sloppy Biased COI

5. Problems with HECs Corruption Bias Carelessness Arbitrariness

6. ThaddeusPope.com BePress.com SSRN.com

11. Ethics Committees Make Decisions Gatekeeper Residual surrogate Adjudicator

12. HEC as Gatekeeper for substituted judgment NY for the OOIE NJ for PVS FL

13. HEC as Residual Surrogate

14. HEC as Adjudicator of Futility Disputes Tex. H&S Code ' 166.046, not modified by , H.B. 3325, Tex. Leg. 81(R)

15. HEC as Adjudicator of OTHER Disputes broad role HI default surrogates of the same class DE

16. De facto authority “ Lumping” Practical barriers to court Judicial deference

20. Mandatory use Optional use Mandatory follow Optional follow

21. Expanding HEC Authority N.Y. S.3164 (Duane) / A.7729 (Gottfried) Mike E. Jorgensen, Today Is the Day We Free Electroconvulsive Therapy? 12 Quinn. Health L.J. 1 (2008).

22. Expanding HEC Authority Idaho S.B. 1114, 60 th Leg. (2009)

23. Expansion Understandable Intractable value conflict Pure procedure

24. Sloppiness Understandable Developed to disclaim power No “stick” = low priority Lack of consensus

25. Expected evolution Due process Power, authority

26. Actual evolution Due process Power, authority

27. Deference to professional judgment Confidence Little risk of error 1970s Parham v. J.R. 1980s Youngberg v. Romeo 1990s Washington v. Harper

28. New reasons for LESS deference Greater focus on COI Greater focus on bias Greater focus on provider values Thicker catalog of HEC errors

29. HEC of Tomorrow Modeled on other IDR (e.g. HCQIA) Modeled on rationing boards TJC standards and/or legal rules Extramural, multi-institutional

30. Thank you

31. Thaddeus Mason Pope , J.D., Ph.D. Widener University School of Law 4601 Concord Pike, Room L325 Wilmington, Delaware 19803 T 302-477-2230 F 901-202-7549 E [email_address] W www.thaddeuspope.com