Panel Selected to Study Ethical Implications of Health Care Proposals : Medicine: The review team will seek to ensure that reform plan does not discriminate, create conflicts or promote unacceptable values.

WASHINGTON — The Clinton Administration, addressing one of the most difficult aspects of its health care reform initiative, has chosen a panel of outside experts to review the ethical implications of the proposals under consideration, according to knowledgeable sources.

The mission of the review team, which is working with the health care reform task force headed by First Lady Hillary Rodham Clinton, is “to lay out a values framework to guide health care reform and hold it accountable,” one source said.

Administration officials want the panel to ensure that proposals in the reform plan do not discriminate against the affected parties, create conflicts of interest, or promote values that would be considered socially or morally unacceptable.

“It will be an ethical foundation for the plan: What values should guide it? How do you hold it accountable?” said the source, who spoke on condition of anonymity. “It will be designed so it can serve as a report card for the nation later.”

This dimension of the Administration’s attempt to overhaul health care will almost certainly prove controversial. Any changes likely will provoke unhappiness and require sacrifices from the various constituencies, including consumers, medical providers and the pharmaceutical and insurance industries.

The area of medical ethics is a minefield. Changes in human behavior and philosophy and advances in medical technology already have inspired a national debate over such sensitive topics as the right to die, abortion, the use of fetal tissue in medical research, the use of human subjects in biomedical research, and--as one example of a thorny health reform issue--the rationing of care.

White House task force officials refused to discuss the work of the ethics group and said that they had prohibited its members from talking publicly about their deliberations.

“What these people are going to be involved in is very controversial--you’ve got people in this group who’ve written on such things as when to pull the plug--and I’m not going to talk about what they are doing, or what they will do,” said Robert Boorstin, spokesman for the health reform task force.

But knowledgeable sources said the ethics group will attempt to resolve or at least make the Administration aware of potential ethical dilemmas raised by various options that will be considered by the task force.

“There is considerable interest in the ethics group integrating its perspective into the ongoing deliberations of the various working groups” involved in the task force, one source said. “As they are developing their proposals, we will try to shape and influence what they do.”

The ethics group also plans to draft an overall set of standards, or values, for the major concepts of the health plan. As it is carried out in the coming years, it will be measured against this ethical blueprint, sources said.

“For example, our society has had a value called ‘equal opportunity’ for a long time,” one source said. “No one thinks we’re there yet. But we still use that value as a yardstick of social progress. That’s the sort of thing the ethics group will be expected to do, to establish those kinds of values and standards for a new health care system.”

For instance, members of the group will take a concept promoted as one major component of the plan--such as universal coverage--and attempt to define exactly what it should mean, sources said.

“Does it mean everyone (is covered) at once? Or people are phased in?” one source said. “Does it mean it should include everyone? Aliens, for example? What does universal coverage mean? The group will define what it means--and, five years from now, if you don’t have it, you’ve failed.”

Existence of the ethics panel was confirmed Thursday by Paul Starr, a senior task force member, who spoke to members of the American College of Physicians here. Starr is a Princeton sociology professor and author of the 1984 Pulitzer Prize winning book, “The Social Transformation of American Medicine.”

Members of the ethics group include medical ethicists, legal experts, representatives from religious organizations and others who have been involved in studying these issues, sources said.

Among them are Nancy Dubler, a medical ethicist at Montifiore Medical Center in the Bronx who last year served on an advisory panel to the Food and Drug Administration that deliberated the fate of silicone gel breast implants, and Arthur Caplan, director of the biomedical ethics center at the University of Minnesota.

Others include Patricia King, a Georgetown University law professor; Larry Gostin, executive director of the American Society of Law and Medicine at Harvard University, and Dr. Zeke Emmanuel, a physician/ethicist at the Harvard University School of Medicine.

Times staff writer Edwin Chen contributed to this story.