Hospital ethics committees in Israel: structure, function and heterogeneity in the setting of statutory ethics committees

Ethics committees in hospitals are a relatively new phenomenon. Such bodies have been in existence for less than 40 years worldwide and their precise roles and methods of functioning continue to evolve. Ethics committees are particularly new to Israeli hospitals. ¹ Until recently few hospitals in Israel had functioning ethics committees, and the role of such committees has not been well defined. ² Such nascent development of hospital ethics committees in Israel is ironic because Israel may be the only country that has a statutorily prescribed role for ethics committees. ³ According to the Patient's Rights Act passed by the Israeli Knesset in May 1996, ethics committees have four legal functions:

1. To allow provision of treatment against a patient's will: "Should the patient be deemed to be in grave danger but reject medical treatment, which in the circumstances must be given soon, the clinician may perform the treatment against the patient's will, if an ethics committee has confirmed that all the following conditions obtain: (a) the patient has received information as required to make an informed choice; (b) the treatment is anticipated to significantly improve the patient's medical condition, and (c) there is a reasonable grounds to suppose that, after receiving treatment, the patient will give his retroactive consent."

2. To allow withholding of information important for informed consent from a patient: ". . .the clinician may withhold medical information from the patient concerning his medical condition if an ethics committee has confirmed that giving this information is likely to cause serious harm to the patient's mental or physical health". Similarly, ethics committee consultation is required to withhold medical records from a patient.

3. To allow disclosure of medical information against a patient's wishes to protect public health or the health of a third party.

4. To review documentation in a case handled by the control and quality committee.

The Patients' Rights Act prescribes the form of the ethics committee as follows: "The Director-General (of the Ministry of Health) shall appoint ethics committees: each such committee shall comprise five members as follows: (1) a person qualified to be appointed District Court Judge . . . [as] Chairman of the Committee; (2) two specialist physicians, from different specializations; (3) a psychologist or social worker, and...