Developing standards for institutional ethics committees: lessons from theNetherlands

educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a l arge number of health care institutions. Though the IEC has become a genera lly, accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experi ence a gap between the IEC and the reality of the clinical environment. Ar this moment, there is interest in developing programmes which educate pract itioners in moral issues and how to deal with them, using the method of a s tructured debate on the ward. The IEC will nor be made obsolete by this dev elopment, bur can play a guiding role in the implementation of such program mes. Current concerns are the lack of patient representation in the Dutch I EC, and the loss of contact with the local community of health care practit ioners because of the merger of hospitals into bodies similar to UK Nationa l Health Service (NHS) trusts.