President Carter will swear in a new commission Monday to monitor the ethics of health care and to investigate whether the way doctors and the nation treat the poor violates medical ethics.
The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research was created by order of Congress, thanks largely to the president's chief opponent for the Democratic presidential nomination, Senate health subcommittee chairman Edward M. Kennedy (Mass.).
The White House opposed the Kennedy measure, saying ethical problems could be handled by existing agencies. But the president recently ordered funds allocated to the new body and is expected to endorse its congressionally mandated scrutiny of gaps in health care and examination of at least four other ethical issues:
How to move ahead in genetic screening and prevention of birth defects and retardation, when one of the main methods used -- prenatal studies of the fetus -- sometimes makes parents choose abortion, a step repugnant to many persons.
How to protect individuals' medical records in a day when they are being computerized and often traded between insurance firms, employers and government agencies.
How to give patients the right to truly informed consent to many complicated new medical procedures, as well as to medical and behavioral experiments.
How to get all states, doctors and hospitals to agree on a uniform definition of death to avoid continuing controversies and court cases over when a patient -- typically a brain-injured patient in a coma -- has died and when life supports can be ended.
Congress specified that all these areas should be examined, as well as the highly touchy new one: the question of the ethics in "differences in availability of health services" in this country, as determined by income or dwelling place.
There is also a serious difference between care of the old and the rest of the population, the new commission's chairman, Morris Abram, is expected to say in his opening remarks Monday.
Abram, New York lawyer and former president of Brandeis University, headed a New York state commission that probed nursing home care and finances in 1975-76 and produced recommendations that led to 10 new state laws.
In an interview yesterday, Abram said he will say that some "spotty medical care" was unavoidable when medicine could do little for the sick, but that any disparity in care is unacceptable in this day when "access makes a demonstrable difference" in health.
The new commission is charged with overseeing the ethics of research and medical care conducted or financed by all federal agencies, specifically including the Defense Department and Central Intelligence Agency. Both of these agencies have admitted to unethical experiments.
The 11-member commission will convene Monday afternoon to hear about past federal ethics efforts, then will meet Tuesday to begin to decide on priorities. The members also will consider examining other topics, including how to compensate persons who are injured during medical research.
Other commission members include Albert Jonsen, widely known ethics professor at the medical school of the University of California at San Francisco, and Patricia King, associate law professor at Georgetown University.
Both Jonsen and King served on a history-making ethics body, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. It was named by Congress in 1974 at the same time Congress ordered a moratorium on any research involving a human fetus.
The commission convinced the Department of Health, Education and Welfare, the main government sponsor of medical research, to continue some essential fetal research to benefit newborns and mothers, but under strict ethical limits.
That commission also prompted the government to end all research on prisoners.