Abstract

In the last decade, and particularly in the last five years, American medicine has rushed to embrace a "new" administrative mechanism to help resolve ethical issues in hospital care: the institutional ethics committee . The IEC can be viewed as a decentralized institution for making both ethical and economic choices about health care services. We inquire whether it is better than alternative political arrangements for some or all of these determinations. Focus is on the institutional nature of the committees themselves , the methods and scope of their ethical and economic decision-making, and the ways in which this particular medical arrangement might relate to society's moral and allocative preferences. IECs as evolved have three principal functions: education, policy-making, and casework. We suggest the last of these is most critical, and argue for limitations on the perspective and procedures that are brought to this task. We also defend the imposition of at least minimal legal and/or regulatory constraints on IECs