The history of institutional ethics at Baylor University Medical Center.

BAYLOR UNIVERSITY MEDICAL CENTER PROCEEDINGS VOLUME 17, NUMBER 1 73 BUMC PROCEEDINGS 2004;17:73–82 Robert L. Fine, MD The discipline of clinical medical ethics guides both the moral stance of the total institution as well as the specific ethical decisions of physicians, nurses, and other health care providers. None would quarrel with the fact that a health care institution as a caring entity must have an ethical stance. This is made necessary by the obvious distinction between the pragmatic question of what can be done to patients within modern health care and the ethical question of what should be done for patients. The notion that an institution’s ethical stance might be determined by a set of ideas rather than the needs of a particular vested interest is not always so obvious. It is nonetheless true that ideas drove the formation both of this great institution and the institutional ethics committee (IEC). As John Maynard Keynes wrote in 1936, “The power of vested interests is vastly exaggerated compared with the gradual encroachment of ideas. . . . Soon or late, it is ideas, not vested interests, which are dangerous for good or evil” (1). In our case, the ideas in question have served to promote a higher good. The Rev. Dr. George W. Truett set forth a challenging idea in 1903, at the founding of a new, small, community hospital, the Texas Baptist Memorial Sanitarium, which during the following century grew and developed into Baylor University Medical Center (BUMC) and Baylor Health Care System (BHCS). Dr. Truett’s prophetic challenge was to establish “a great humanitarian hospital, one to which men of all creeds and those of none may come with equal confidence.” The idea of creating a humanitarian institution for the sake of patients first, as well as ethical positions articulated by the institution’s trustees, physician leadership, and senior administrators, set the standards that guided physician practice and institutional care for 6 decades. However, a more specific idea about medical ethics and its proper role in day-to-day clinical practice would be introduced in due time and would have a more profound impact on the ethical stance of the institution than any idea since Dr. Truett’s prophetic words of 1903. This idea was to create a multidisciplinary ethics committee designed to serve the needs of patients, health care practitioners of all disciplines, and the community as a whole, rather than the needs of powerful vested interests. By first serving these other groups, the traditional interests of the trustees, physicians, and administrators would ultimately be better served as well.