Wesley Smith Is Right: No Star Chamber Secrecy for Futility Disputes

Last Saturday, Wesley J. Smith repeated a metaphor that he has been using for a few years to describe the resolution of medical futility disputes by intramural hospital committees:  "star chambers."  





Pointing both to the recent Albert Barnes case in Minnesota and a case in which he was involved, Smith argues that "disputes over whether to continue wanted life sustaining treatment belong in court, not in secret and confidential bioethics committee meetings."  His post was not a categorical opposition to unilateral decisions to withhold or withdraw life-sustaining treatment (as he has made in the past).  Rather, he attacks the process by which many such decisions are reached.  





I mostly agree with Smith on this one.  Indeed, I have written-- here and here and here -- about the unfairness of having intramural ethics committees decide life and death conflicts.  And I am continuing that line of argument both in an "Legal Briefing: Healthcare Ethics Committees," forthcoming in The Journal of Clinical Ethics 22(1), and in a piece this summer.  But while I agree with Smith's criticism, I am not sure I agree with his solution:  "proper venue is in front of a judge in open court, with witnesses under oath, a public record, the right to cross examination, and appeal."  Dispute resolution process through a trial court is too slow, too cumbersome, too expensive.  The competence and neutrality of the decision maker can instead be provided by independent ethics committees or by specialized tribunals like Ontario's CCB.