Ethics committees in neonatal care: Substantive protection or procedural diversion?

New decision-making procedures will ultimately be judged on the basis of three criteria: accuracy, efficiency, and social acceptability. Ethics committees will probably be as accurate as the current doctor-patient model, and more accurate if they can gather relevant information that might not otherwise be considered; less efficient in terms of time and effort; and worthy of public acceptability only if their primary function is the protection of the infant. If their primary function is protection of the institution, such committees wil serve only to postpone the day of patient-centered reform by temporarily creating the illusion that something is being done to protect vulnerable patients. Experimentation with such committees seems in order; but it is premature to pretend that they can solve the very difficult substantive issues raised by neonatal rescue medicine by simply adding a procedural layer to the decision-making process. The development of substantive standards for decision making remains our first priority.