Miller and Mackler's letter illuminates the intent of the New York State Task Force on Life and the Law regarding the authority of institutional ethics committees. Although we are encouraged that the Task Force did not mean to propose giving physicians "special or automatic immunity for following the advice of an ethics committee," we remain concerned about the clarity of their 1992 document [1].

Appendix A of section 11, Bioethics review committees, part C, page 262, states: "Recommendations and advice by the bioethics review committee shall be advisory and nonbinding, except for committee approvals or disapprovals of the withdrawal or withholding of life-sustaining treatment from an emancipated minor patient, from an adult patient without a surrogate, or from any patient who is neither terminally ill nor permanently unconscious." We believe it fair to interpret this statement to mean that advice from a committee is binding when it involves foregoing treatment for the aforementioned patient categories. Our interpretation was echoed in an article in Hospital Ethics^[2] that stated: "In cases involving life-sustaining treatment decisions, the proposed legislation would make the forgoing of such treatment subject to the review and approval of multidisciplinary institutional ethics committees"

In Appendix A of section 13, Immunity, part 2, page 266, the New York Task Force states, "No health care provider or employee thereof shall be subjected to criminal or civil liability, or be deemed to have engaged in unprofessional conduct, for honoring in good faith a health care decision made pursuant to this article or for other actions taken in good faith pursuant to this article." We infer from this statement that professionals who follow a committee's recommendation receive immunity.

We maintain that the current document implies that immunity is provided for those who follow committee advice in cases involving foregoing life-sustaining treatment for patients without decision-making capacity and without surrogate decision makers. Immunity is not conferred on those who consult a committee about other types of decisions.

Consequently, the "broad protection" that concerns us is conferred in the most troubling cases, including cases in which no one can speak for the patient. We hope the Task Force will clarify this ambiguity.