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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 LawWidener University School of Law

6th Int’l Conf. Clinical Ethics Consultation

Portland, Oregon Portland, Oregon $$ May 14, 2010 May 14, 2010

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Due ProcessThe price of deference

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Presume

Medical judgment is best

Unless

Uninformed Sloppy Biased COI

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Problems with HECs

Corruption

Bias

Carelessness

Arbitrariness

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ThaddeusPope.com

BePress.com

SSRN.com

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Ethics Committees Make Decisions

Gatekeeper

Residual surrogate

Adjudicator

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HEC as Gatekeeper

for substituted judgmentNY

for the OOIENJ

for PVSFL

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HEC as Residual Surrogate

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HEC as Adjudicator of Futility Disputes

Tex. H&S Code ' 166.046, not modified by, H.B. 3325, Tex. Leg. 81(R)

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HEC as Adjudicator of OTHER Disputes

broad roleHI

default surrogates of the same class

DE

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De facto authority

“Lumping”

Practical barriers to court

Judicial deference

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Mandatory

use

Optional

use

Mandatory

follow

Optional

follow

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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).

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Expanding HEC Authority

Idaho S.B. 1114,

60th Leg. (2009)

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Expansion Understandable

Intractable value conflict

Pure procedure

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Sloppiness Understandable

Developed to disclaim power

No “stick” = low priority

Lack of consensus

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Expected evolution

Due process

Power, authority

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Due process

Power, authority

Actual evolution

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Deference to professional judgment

Confidence

Little risk of error

1970s Parham v. J.R.

1980s Youngberg v. Romeo

1990s Washington v. Harper

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New reasons for LESS deference

Greater focus on COI

Greater focus on bias

Greater focus on provider values

Thicker catalog of HEC errors

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HEC of Tomorrow

Modeled on other IDR (e.g. HCQIA)

Modeled on rationing boards

TJC standards and/or legal rules

Extramural, multi-institutional

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Thank you

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Thaddeus Mason Pope, J.D., Ph.D. Widener University School of Law4601 Concord Pike, Room L325Wilmington, Delaware 19803T 302-477-2230F 901-202-7549E tmpope@widener.eduW www.thaddeuspope.com