Although American hospitals are required to have ethics committees, doctors shun them. According to a survey published last year, an average committee dealt with only three cases a year. The committees are meant to improve outcomes for patients, but many doctors suspect that they are worse than useless. “If ethics committees were a drug,” Howard Brody, director of the University of Texas Medical Branch's Institute for Medical Humanities, told American Medical News, "they would not be approved."

In the eyes of clinicians, the practical problems of using a committee are legion. Less than half of committee members have formal training in bioethics, and only one in 20 has a bioethics degree of some sort. Advice tends to be vague and biased towards compromise. Doctors fear that they undermine their own ethical responsibility to patients. Furthermore, no standards currently exist for a successful ethical consultation.

In any case, the skill of identifying ethical issues is not easily learned. "Bioethicists are extremely good if you come to us wearing a sandwich board that says, 'I am an ethical issue.' Then we can give you good advice based on rules, cases, ethics, with all the footnotes," says Dr Brody. "But if what you want to know is how to see what's an ethical problem, something that happens in the clinical work flow and doesn't have 'ethics' printed at the top of the page, then I'm not sure we know how to teach that." ~ American Medical News, Jan 28