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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 Law. 6 th Int’l Conf. Clinical Ethics Consultation Portland, Oregon $ May 14, 2010. Due Process - PowerPoint PPT Presentation
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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
FL for PVS
NJ for the OOIE
NY for substituted judgment
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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
DE default surrogates of the same class
HI broad role
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De facto authority
“Lumping”
Practical barriers to court
Judicial deference
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Optional
follow
Mandatory
follow
Optional
use
Mandatory
use
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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 [email protected] www.thaddeuspope.com
