Health Care Ethics Committees (HECs) – a useful instrument for legal compliance?
DOI:
https://doi.org/10.46941/2025.se1.8Keywords:
Health care ethics committee, ethics consultation, hospitals, legal compliance, patient rights, patient´s well-being, legal conformity, prevention.Abstract
Until now, health care respective hospital ethics committees (HECs) have hardly been considered as an instrument of compliance. This article presents an initial review of this established structure from the point of view of legal compliance. To this end, the emergence, dissemination, and functioning of HECs in the USA and Germany are presented and questions of quality are addressed. The extent to which the structure of ethics committees in health care facilities can be viewed and utilized as a compliance tool is examined in relation to compliance as a means of ensuring legal conformity, preventing legal violations, and as a compliance culture. It is shown that HECs are suitable as a compliance tool if they function well, but that some improvements are still needed, especially with regard to the ethical and legal expertise of the counselors and the financial resources of the structure.
References
Alexander, S. (1962) ‘They decide who lives, who dies‘, Life Magazine, 53(20), pp. 102–125.
Annas, G., Grodin, M. (2016) ‘Hospital Ethics Committees, Consultants, and Courts‘, AMA Journal of Ethics, 18 (5), pp. 554–559; https://doi.org/10.1001/journalofethics.2016.18.5.sect1-1605.
Aulisio M. P. (2014) ‘Clinical Ethics. I. Development, Role, and Methodologies‘, in Jennings, B. (ed.) Bioethics. Vol. 2. 4th ed. Farmington Hills, MI: Macmillan, pp. 596–602.
Aulisio, M. P. (2016) ‘Why Did Hospital Ethics Committees Emerge in the US?‘, AMA Journal of Ethics, 18(5), pp. 546–553; https://doi.org/10.1001/journalofethics.2016.18.5.mhst1-1605.
Baker, R. (2022) ‘A Brief Introduction to the History of Clinical Ethics‘, in Wasson, K., Kuczewski, M. (eds.) Thorny Issues in Clinical Ethics Consultation. North American and European Perspectives. Cham: Springer, pp. 3–12; https://doi.org/10.1007/978-3-030-91916-0_1.
Beauchamp, T. L., Childress, J. F. (2019) Principles of Biomedical Ethics. 8th ed. Oxford: Oxford University Press.
Bobbert, M. (2009) ‘Klinische Ethikberatung – Ein hermeneutisch-normatives Modell‘, in Baumann-Hölzle, R., Arn, C. (eds.) Handbuch Ethik im Gesundheitswesen. Bd. 3: Ethiktransfer in Organisationen. Basel: EMH und Schwabe AG, pp. 187–202.
Bockenheimer-Lucius, G., May, Arnd T. (2007) ‘Ethikberatung – Ethikkomitee in Einrichtungen der stationären Altenhilfe (EKA). Eckpunkte für ein Curriculum‘, Ethik in der Medizin, 19(4), pp. 331–339; https://doi.org/10.1007/s00481-007-0530-6.
Brody, H. (2010) ‘The Physician-Patient Relationship‘ in Wedding, D., Stuber, M. L. (eds.) Behaviour and Medicine. 5th ed. Cambridge: Hogrefe, 187-198.
Bundesärztekammer (BÄK) (2006) ‘Zentrale Kommission zur Wahrung ethischer Grundsätze in der Medizin und ihren Grenzgebieten bei der Bundesärztekammer (ZEKO), Ethikberatung in der klinischen Medizin‘, Deutsches Ärzteblatt, 103(24), pp. A1703–1707.
Bundesärztekammer (BÄK) (2019) ‘Stellungnahme der Zentralen Kommission zur Wahrung ethischer Grundsätze in der Medizin und ihren Grenzgebieten (Zentrale Ethikkommission), Außerklinische Ethikberatung‘, Deutsches Ärzteblatt, 117(12), pp. A1–A8; https://doi.org/10.3238/baek_sn_aeb_2019.
Dannecker, G. (2023) ‘Compliance – Domestic and International Good Practices: Tendenz zur Verrechtlichung ethischer und unternehmensinterner Regeln‘, in Beisel, H., Laue, C., Meier, B.-D. (eds.) Die Kriminalwissenschaften als Teil der Humanwissenschaften. Festschrift für Dieter Dölling zum 70. Geburtstag. Baden-Baden: Nomos, pp. 131–155.
Dannecker, G (2025) ‘Compliance as Strategy to Avoid Criminal, Administrative, and Civil Sanctions‘, European Integration Studies, 21(1) (in print).
Deutscher Evangelischer Krankenhausverband e.V. und Katholischer Krankenhausverband Deutschlands e.V. (1997) Ethik-Komitee im Krankenhaus. Erfahrungsberichte zur Einrichtung von Klinischen Ethik-Komitees. Stuttgart: Selbstverlag.
Dörries, A., Simon, A., Marckmann, G. (2015) ‘Ethikberatung im Krankenhaus – Sachstand und kritischer Ausblick‘, Ethik in der Medizin, 27(3), pp. 249–253; https://doi.org/10.1007/s00481-015-0361-9.
Engelhardt, T. Jr. (1995) The Foundation of Bioethics. 2nd ed. Oxford: Oxford University Press.
Fox, E., Danis, M., Tarzian, A. J., Duke, C. C. (2022) ‘Ethics Consultation in U.S. Hospitals: A National Follow-Up Study‘, The American Journal for Bioethics, 22(4), pp. 5–18; https://doi.org/10.1080/15265161.2021.1893547.
Fox, E., Myers, S., Pearlman, R. A. (2007) ‘Ethics Consultation in United States Hospitals: A National Survey‘, American Journal of Bioethics, 72, pp. 13–25; https://doi.org/ 10.1080/15265160601109085
Frewer, A, Fahr, U., Rascher, W. (eds.) (2008) Klinische Ethikkomitees. Chancen, Risiken und Nebenwirkungen. Würzburg: Königshausen & Neumann.
Gerald N., Alfred S., Vollmann, J. (eds.) (2010) Klinische Ethikberatung. Ein Praxisbuch für Krankenhäuser und Einrichtungen der Altenpflege. 2nd ed. Stuttgart: Kohlhammer.
Gewirth, A. (1978) Reason and Morality. Chicago: University of Chicago Press.
Guadagno, R. E. (2017) ‘Compliance‘, in Harkins, S. G., Williams, K. D., Burger, J. M. (eds.) Oxford Handbook of Social Influence. Oxford: Oxford University Press, pp. 107–127; https://doi.org/10.1093/oxfordhb/9780199859870.013.4.
Hajibabaee, F., Soodabeh, J., Mohammad, A. C., Pooneh, S., Patricia, R. (2016) ‘Hospital/Clinical Ethics Committees‘ Notion: an Overview‘, Journal of Medical Ethics and History of Medicine, 9(17), pp. 1–9.
Hauschka, C. E., Moosmayer, K., Lösler, T. (eds.) (2016) Corporate Compliance. Handbuch der Haftungsvermeidung in Unternehmen. 3rd. ed. München: Beck.
Hester, M. D., Schonfeld, T. L. (2022) Guidance for Healthcare Ethics Committees. 2nd ed. Cambridge: Cambridge University Press; https://doi.org/10.1017/9781108788250.
Kettner, M. (2008) ‘Autorität und Organisationsformen Klinischer Ethikkomitees‘, in Frewer, A., Fahr, U., Rascher, W. (eds.) Klinische Ethikkomitees. Chancen, Risiken und Nebenwirkungen. Würzburg: Königshausen und Neumann, pp. 15–28.
Knierim, T. C. (2025) ‘Compliance‘, in Wabnitz, H.-B., Janovsky, T., Schmitt, L. (eds.) Handbuch Wirtschafts- und Steuerrecht. München: Beck, pp. 387–434.
KTQ GmbH: Kooperation für Transparenz und Qualität im Krankenhaus (2004) KTQ-Katalog. Düsseldorf: KTQ-GmbH.
May, A. T. (2010) ‘Ethikberatung – Formen und Modelle‘, in Heinemann, W., Maio, G. (eds.) Ethik in Strukturen bringen. Freiburg/Br: Herder, pp. 80–102.
Musil, R. (2014) Der Mann ohne Eigenschaften. Erstes und zweites Buch. Hamburg: Rowohlt.
Farber Post, L., Blustein, J. (2021) Handbook for Health Care Ethics Committees. 3rd ed. Baltimore: John Hopkins University Press.
Rothärmel, S. (2010) ‘Rechtsfragen Klinischer Ethikberatung‘, in Dorries, A. et al. (eds.) Klinische Ethikberatung. Ein Praxisbuch für Krankenhäuser und Einrichtungen der Altenpflege. Stuttgart: Kohlhammer, pp. 178–185.
Rotsch, T. (2024) ‘Criminal Compliance‘, in Achenbach, H., Ransiek, A., Rönnau, T. (eds.) Handbuch Wirtschaftsstrafrecht. 6th ed. Heidelberg: C.F. Müller, pp. 61–128.
Scherzinger, G., Bobbert, M. (2017) ‘Evaluation of Research Ethics Committees: Criteria for the Ethical Quality of the Review Process’, Accountability in Research, 12(3), pp. 152–176; https://doi.org/10.1080/08989621.2016.1273778.
Schochow, M., Schnell, D., Steger, F. (2019) ‘Implementation of Clinical Ethics Consultation in German Hospitals‘, Science and Engineering Ethics, 25, pp. 985-991; https://doi.org/10.1007/s11948-015-9709-2.
Schoppmeyer, M. (2020) ‚Compliance [Physiologie]‘, in Pschyrembel online, Berlin: de Gryuter. [Online]. Available at: Pschyrembel Online | Compliance [Physiologie] (Accessed: 8 March 2025).
Singer, P. (2011) Practical Ethics. 3rd ed. Cambridge: Cambridge University Press.
Steinkamp, N., Gordijn, B. (2005) Ethik in der Klinik. Ein Arbeitsbuch. 2nd. ed. Neuwied-Köln/München: Luchterhand.
Ten Have, H., do Céo Patrão Neves, M. (2021) ‘Clinical Ethics Consultation‘, in Ten Have, H., do Céo Patrão Neves, M (eds.) Dictionary of Global Ethics, Cham: Springer; https://doi.org/10.1007/978-3-030-54161-3_129.
Tong, R. (1991) ‘The Epistemology and Ethics of Consensus: Uses and Misuses of ‘Ethical’ Expertise‘, Journal of Medicine and Philosophy, 16(4), pp. 409–426; https://doi.org/10.1093/jmp/16.4.409.
Wasson, K., Kuczewski, M. (eds.) (2022) Thorny Issues in Clinical Ethics Consultation. North American and European Perspectives. Cham: Springer; https://doi.org/10.1007/978-3-030-91916-0.
Wirtz, M. A. (eds.) (2025) Dorsch. Lexikon der Psychologie, Lemma: Compliance. Bern: Hogrefe. [Online]. Available at: https://dorsch.hogrefe.com/stichwort/compliance (Accessed: 16 February 2025).
Akademie für Ethik in der Medizin e.V. (AEM) Vorstand (2019) Curriculum Ethikberatung im Gesundheitswesen. [Online]. Available at: https://www.aem-online.de/fileadmin/user_upload/Curriculum_Ethikberatung_im__Gesundheitswesen_2019-06-24.pdf (Accessed: 04 March 2025).
Akademie für Ethik in der Medizin e.V. (AEM) Vorstand (2010) ‚Ethikberatung im Krankenhaus Standards für Ethikberatung in Einrichtungen des Gesundheitswesens‘, Ethik in der Medizin, 22(2), pp. 149–153; https://doi.org/10.1007/s00481-010-0053-4.
American Medical Association (AMA) (2022) Code of Medical Ethics. 2nd ed.
American Medical Association (AMA) (2022) Code of Medical Ethics. 10.7 Ethics Committees in Healthcare Institutions. [Online]. Available at: https://policysearch.ama-assn.org/policyfinder/detail/faith?uri=%2FAMADoc%2FEthics.xml-E-10.7.xml (Accessed: 05 March 2025).
American Society for Bioethics and Humanities (1998) Core Competencies for Health Care Ethics Consultation. Glenview, Ill: ASBH.
American Society for Bioethics and Humanities (2011) Core Competencies for Health Care Ethics Consultation. 2nd ed., Glenview, Ill: ASBH.
American Society for Bioethics and Humanities (2024) Core Competencies for Health Care Ethics. 3rd ed., Glenview, Ill: ASBH.
Arbeitsgruppe ‚Ethikberatung im Gesundheitswesen‘ der Akademie für Ethik in der Medizin (AEM) (2013) ‚Empfehlungen zur Evaluation von Ethikberatung in Einrichtungen des Gesundheitswesens‘, Ethik in der Medizin, 25(2), pp. 149–156; https://doi.org/10.1007/s00481-012-0230-8.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983) Deciding to Forego Life-Sustaining Treatment. Washington. D.C: U.S. Government Printing Office. (Im Anhang: Modellentwurf für die Satzung zukünftig einzurichtender Ethikkomitees.)
Regierungskommission (2022) Deutscher Corporate Governance Codex (DCGK) in der Fassung vom 28.04. 2022 [Online]. Available at: https://www.dcgk.de//files/dcgk/usercontent/de/download/kodex/220627_Deutscher_Corporate_Governance_Kodex_2022.pdf (Accessed: 3 March 2025).
World Medical Association (1964 respective 2024) Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants. Geneva. [Online]. Available at: (Accessed: 16 February 2025).


