Abstract
In the United Kingdom there is a growing conviction that CECs have an important role to play in helping health care professionals address ethical dilemmas. For example, the Royal College of Physicians, the Nuffield Trust and the unofficial Clinical Ethics Network, which has received financial support from the Department of Health, commend the use of CECs in the UK. The growth of such committees has been influenced by the legal and policy support they have received in the United States. However, there is increasing concern about both the benefits and the quality of work produced by CECs. In addition, despite the rapid increase in the number of CECs in the UK, outside of the United States they remain under-researched and no formal mechanism exists to assess their performance. As a result we know little about the structure, function, impact and effectiveness of CECs. We are currently conducting a research project funded by the Wellcome Trust that seeks to interrogate the competing claims regarding the benefits and disbenefits of CECs. This initial account of our research provides a detailed analysis of theoretical issues that surround the development and use of CECs and points towards the questions that lie at the heart of the social science strand of our project.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 221-237 |
| Number of pages | 17 |
| Journal | Medical Law International |
| Volume | 8 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2007 |
| Externally published | Yes |
ASJC Scopus subject areas
- Law
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Clinical ethics committees in the United Kingdom : Towards evaluation. / Williamson, Laura; McLean, Sheila; Connell, Judith.
In: Medical Law International, Vol. 8, No. 3, 2007, p. 221-237.Research output: Contribution to journal › Review article › peer-review
}
TY - JOUR
T1 - Clinical ethics committees in the United Kingdom
T2 - Towards evaluation
AU - Williamson, Laura
AU - McLean, Sheila
AU - Connell, Judith
N1 - Funding Information: Williamson Laura McLean Sheila Connell Judith 1 University of Glasgow 9 2007 8 3 221 237 © 2007 A B Academic Publishers—Printed in Great Britain 2007 A B Academic Publishers—Printed in Great Britain In the United Kingdom there is a growing conviction that CECs have an important role to play in helping health care professionals address ethical dilemmas. For example, the Royal College of Physicians, the Nuffield Trust and the unofficial Clinical Ethics Network, which has received financial support from the Department of Health, commend the use of CECs in the UK. The growth of such committees has been influenced by the legal and policy support they have received in the United States. However, there is increasing concern about both the benefits and the quality of work produced by CECs. In addition, despite the rapid increase in the number of CECs in the UK, outside of the United States they remain under-researched and no formal mechanism exists to assess their performance. As a result we know little about the structure, function, impact and effectiveness of CECs. We are currently conducting a research project funded by the Wellcome Trust that seeks to interrogate the competing claims regarding the benefits and disbenefits of CECs. This initial account of our research provides a detailed analysis of theoretical issues that surround the development and use of CECs and points towards the questions that lie at the heart of the social science strand of our project. Funding Information: 1 Institute of Law and Ethics in Medicine, University of Glasgow. The study ‘Ethico-Legal Governance in Health Care’ is funded by the Wellcome Trust (ref. 07446). Additional financial support was provided by NHS Grampian. 1 Cranford, R.E., and Doudera, A..E., ‘The Emergence of Institutional Ethics Committees,’ in Cranford, R.E., and Doudera, A..E. (eds.) Institutional Ethics Committees and Health Care Decision Making , Michigan, Health Administration Press, 1984. 5–21; 2 Dougherty, C.J., ‘Clinical Ethics: Institutional Ethics Committees,’ in Encyclopedia of Bioethics, Post, S , (ed), 444–447, New York, Macmillan Reference, 2004; Slowther, A., Hope, T., ‘Clinical ethics committees’ British Medical Journal 2000, 32: 649–650; Doyal, L., ‘Clinical ethics committees and the formulation of health care policy’, Journal of Medical Ethics 2001; 27 Suppl 1: 144–149. 3 Nelson, R.M., Shapiro, R.S., ‘The role of an ethics committee in resolving conflict in the neonatal intensive care unit’, Journal of Law, Medicine & Ethics , 1995; 23: 27–32. 4 Hoffman, D.E., Regulating Ethics Committees in Health Care Institutions — Is It Time?’. 50 Maryland Law Review 1991: 746–797, at p. 747 5 Fletcher, J.C., and Hoffmann, D.E., ‘Ethics Committees: Time to Experiment with Standards,’ Annals if Internal Medicine , 120, 4, 1994, 335–338; Dougherty, C.J., ‘Clinical Ethics: Institutional Ethics Committees,’ Encyclopedia of Bioethics , Post., S., 444–447, New York, Macmillan, 2004. 6 Matter of Quinlan 355 A.2d 647 7 President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research, Deciding to Forego Life-Sustaining Treatment , Washington, D.C., US Government Printing Office, 1983. 8 Department of Health and Human Services, ‘Nondiscrimination on the Basis of Handicaps: Procedures and Guidelines Relating to Health Care for Handicapped Infants,’ Federal Register , 1984, 622–54. 9 Matter of Quinlan 355 A.2d 647. 10 at p. 668. 11 Id. 12 Id. 13 cf Teel, K., ‘The Physician’s Dilemma a Doctor’s View: What The Law Should be,’ Baylor Law Review , 27, 6, 1975. 14 at p. 669. 15 Id. 16 Superintendent of Belchertown State Hospital v Saikewicz 373 Mass. 728 (1977), at p. 759 17 Re AC 573 A.2d 1235 (D.C. 1990). 18 per Terry, J. at p.1237 n.2. 19 JCAHO, Accreditation Manual for Hospitals , Oakbrook Terrace, JACHO, 1992. 20 Corsino, B.V., ‘Bioethics Committees and JCAHO Patients’ Rights Standards: A Question of Balance,’ The Journal of Clinical Ethics , 7, 2, 177–181. 21 Fletcher, JC., &Hoffmann, D.E., ‘Ethics Committees: Time to Experiment with Standards,’ Annals of Internal Medicine , 1994, 120, 4, 335–338. 22 Povar, G.J., ‘Evaluating Ethics Committees: What do we mean by Success?’ Maryland Law Review , 1991, 50, 904–919 at p. 906; Van Allen, E et al. ‘Evaluating Ethics Committees’, Hastings Center Report , 9, 5, 1989, 23–24 at p.23. 23 Hoffmann, D.E., ‘Evaluating Ethics Committees: A View from the Outside,’ Milbank Quarterly , 71, 4, 677–701, 1993, at p. 679. 24 American Society for Bioethics and Humanities, Core Competencies for Health Care Ethics Consultation , Glenview, IL, ASBH, 1998 25 American Society for Bioethics and Humanities, Core Competencies for Health Care Ethics Consultation , Glenview, IL, ASBH, 1998, at p. 27. 26 Id. 27 Hoffman, loc cit , at p. 763. 28 Lo ,B., ‘Behind closed doors. Promises and pitfalls of ethics committees’, N Eng J Med 1987; 317:46–50; La Puma, J., Stocking, C., Darling, C., Siegler, M., ‘Community hospital ethics consultation: evaluation and comparison with a university hospital service’, The American Journal of Medicine , 1992, 92: 346–351; Blake, .DC., ‘The hospital ethics committee. Healthcare’s moral conscience or white elephant?’, Hastings Center Report 1992, 2:6–11; Siegler, M., ‘Ethics committees: decisions by bureaucracy’, 1986, 16:22–4. 29 Orr, R.D., ‘Evaluation of an Ethics Consultation Service: Patient and Family Perspectives,’ American Journal of Medicine , 101, 1996, 135–141; La Puma, et al. , Community Hospital Ethics Consultation: Evaluation and Comparison with a University Hospital Service,’ American Journal of Medicine , 92, 1992, 346–351; McClung, J.A. et al ., ‘Evaluation of Medical Ethics Consultation Service: Opinions of Patients and Health Care Providers,’ 100, 1996, 456–460; Yen, B., and Schneiderman, L.J., ‘Impact of Pediatric Ethics Consultations on Patients, Families, Social Workers, and Physicians’, Journal of Perinatology , 19, 5, 1999, 373–378. 30 Schneiderman, L.J., ‘Impact of Ethics Consultations in the Intensive Care Setting: A Randomized, Controlled Trial,’ Critical Care Medicine , 28, 12, 2000, 3920–3924; Schneiderman, L.J., ‘Effect of Ethics Consultations on Nonbeneficial Life-Sustaining Treatments in the Intensive Care Setting,’ Journal of the American Medical Association , 2003, 290, 9, 1166–1172; Dowdy, M.D., et al. ‘A Study of Proactive Ethics Consultation for Critically and Terminally ill Patients with Extended lengths of Stay,’ Critical Care Medicine , 1998, 26, 2, 252–259. 31 Scheirton, L.S., ‘Determinants of Hospital Ethics Committee Success,’ HEC Forum , 1992, 4, 6, 342–359. 32 American Society for Bioethics and Humanities, Core Competencies for Health Care Ethics Consultation , Glenview, IL, ASBH, 1998; Slowther, A., et al., Clinical Ethics Support in the UK: A Review of the Current Position and Likely Development , London, Nuffield Trust, 2001; Guo, L., and Schick I.C., ‘The Impact of Committee Characteristics on the Success of Healthcare Ethics Committees,’ HEC Forum , 2003, 15, 3, 287–299; Fletcher, J.C., ‘Standards for Evaluations of Ethics Consultation,’ in Ethics Consultation in Health Care , Fletcher, J.C., Quist, N., Jonsen, A.R., (eds) 171–184, Michigan, Health Administration Press, 1989, at p. 173ff. 33 Orr, R.D., and Leon, D.M., ‘The Role of the Clinical Ethicist in Conflict Resolution,’ Journal of Clinical Ethics , 2000, 11, 1, 21–30; Fletcher, J.C., ‘Goals and Process of Ethics Consultation in Health Care,’ Biolaw , 2, 2, 1986, S37–S47; Doyal, L., ‘Clinical Ethics Committees and the Formulation of Health Care Policy,’ Journal of Medical Ethics , 27, Suppl I, 2001, i44–i49; Moreno, J.D. ‘Ethics by Committee: The Moral Authority of Consensus,’ Journal of Medicine and Philosophy , 1988, 13, 411–432; Povar, G.J., ‘Evaluating Ethics Committees: What do we Mean by Success?’ Maryland Law Review , 50, 1991, 904–919. 34 McClung, J.A. et al. , ‘Evaluation of Medical Ethics Consultation Service: Opinions of Patients and Health Care Providers,’ 100, 1996, 456–460; Yen, B., and Schneiderman, L.J., ‘Impact of Pediatric Ethics Consultations on Patients, Families, Social Workers, and Physicians, Journal of Perinatology , 19, 5, 1999, 373–378. 35 Scheirton, L.S., ‘Determinants of Hospital Ethics Committee Success,’ HEC Forum , 1992, 4, 6, 342–359. 36 Schneidermann, L.J., ‘Impact of Ethics Consultations in the Intensive Care Setting: A Randomized, Controlled Trial,’ Critical Care Medicine , 28, 12, 2000, 3920–3924; Schneiderman, L.J., ‘Effect of Ethics Consultations on Nonbeneficial Life-Sustaining Treatments in the Intensive Care Setting,’ Journal of the American Medical Association , 2003, 290, 9, 1166–1172. 37 Beyleveld, D., et al. , ‘Clinical Ethics Committees: Clinician Support or Crisis Management,’ HEC Forum , 14, 1, 2002, 13–25, at p. 17. 38 Ms B v NHS Hospital Trust (2002) 65 BMLR 149. 39 Slowther, A., ‘The Case of Ms B and the “Right to Die’, Journal of Medical Ethics 2002, 28: 243, at p. 243. 40 The Royal Liverpool Children’s Inquiry, London, The Stationery Office (2001). 41 Learning from Bristol: the report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995 , Cm 5207. 42 Review of the research framework in North Staffordshire Hospital NHS Trust available at http://www.doh.gov.u.k.lpdfs/northstaffs.pdf (accessed on 23/02/2007). 43 For more information about the work of this Centre, see http://www.ethox.org.uk and for information of the network see http://www.ethics-network.org.uk/Committee/list.htm (accessed on 16/02/2007). 44 Slowther, A., Johnston, C., Goodall, J., Hope, T., ‘Development of clinical ethics committees’, British Medical Journal 2004, 328: 950–952, at p. 950. 45 Slowther, A., Bunch, C., Woolnough, B., Hope, T., ‘Clinical ethics support services in the UK: an investigation of the current provision of ethics support to health professionals in the UK’, Journal of Medical Ethics 2001;27 suppl I: i2–i8, at p. i.8. 46 Slowther, A-M, Hope, T., ‘Clinical Ethics Committees: they can change clinical practice but need evaluation’, British Medical Journal _Vol. 321, 16 September 2000, 649–650, at p. 650. 47 McCall Smith, A., ‘Committee Ethcs? Clinical Ethics Committees and their Introduction in the United Kingdom,’ Journal of Law and Society , 17, 1, 1990, 124–139; Larcher V, Lask B, McCarthy J., ‘Paediatrics at the Cutting Edge: Do We Need Ethics Committees?’, Journal of Medical Ethics 1997,23: 245–9; Slowther A, Hill D, Mc Millan J., ‘Clinical Ethics Committees: Opportunity or Threat?’, HEC Forum 2002;14 (1):4–12; Slowther A, Underwood M., ‘Is there a need for a clinical ethics supports service in the UK?’, Journal of Medical Ethics 1998;24:207; Slowther A, Johnston C, Goodall J, Hope T., ‘Development of Clinical Ethics Committees’, British Medical Journal 2004, 328: 950–952; Doyal, L., ‘Clinical Ethics Committees and the Formulation of Health Care Policy,’ Journal of Medical Ethics , 27, 2001, Suppl I: i44–i49; Watson A.R., ‘An ethics of clinical practice committee: should every hospital have one?’ HEC Forum 1996;8:301–315; Beyleveld B, Brownsword R, Wallace S., ‘Clinical Ethics Committees: Clinical Support or Crisis Management?’ HEC Forum 2002, 14(1): 13–25. 48 Thomton, J.G, Lilford, R.J., ‘Clinical ethic committees’, British Medical Journal 1995, 311: 667–669 (9 September); Slowther, A., Johnston, C., Goodall, J., Hope, T., ‘Development of clinical ethics committees’, British Medical Journal 2004, 328: 950–952; Doyal, L., Colvin, B., ‘The clinical ethics committee at Barts and the London Hospital Trust: rationale, achievements and difficulties’ HEC Forum 2002, 14 (1) 26–36; Slowther, A., McMillan, J., ‘The development of healthcare (clinical) ethics committees in the UK’, HEC Forum 2002, 14(1): 1–3; Rudd, P., ‘The clinical ethics committee at the Royal united Hospital Bath England’,. HEC Forum 2002;14 (1): 37–44; Larcher, V., ‘Role of clinical ethics committees’, Arch Dis Child 1999, 81: 104–106; Melsin, E., Rayner, C., Larcher, V., Hope, T., Savulescu, J., ‘Hospital Ethics Committees in the UK’, HEC Forum 1996, 8: 301–315; Wood, K., Ellis, S., ‘A Clinical Ethics Committee in a Small Health Services Trust’, Journal of Medical Ethics 1999, 25: 420. 49 Szeremeta, M., Dawson, J., Manning, D., Watson, A., Wright, M., Notcutt, W., Lancaster, R., ‘Snapshots of Five Clinical Ethics Committees in the UK.’ Journal of Medical Ethics 2002, 27: i9–i17. 50 Slowther, A., Bunch, C., Woolnough, B., Hope, T., Clinical ethics support in the UK: a review of the current position and likely development , London, Nuffield Trust, 2001. 51 Slowther, A., Bunch, C., Woolnough, B., Hope, T., Clinical Ethics Support in the UK: A Review of the Current Position and Likely Development London, Nuffield Trust, 2001; Slowther A, Johnston C, Goodall J, Hope T., ‘Development of Clinical Ethics Committees’, British Medical Journal 2004, 328: 950–952; Slowther A, Hill D, Mc Millan J., ‘Clinical Ethics Committees: Opportunity or Threat?’, HEC Forum 2002, 14 (1): 4–12. 52 Slowther, A., Bunch, C., Woolnough, B., Hope, T., Clinical Ethics Support in the UK: A Review of the Current Position and Likely Development London, Nuffield Trust, 2001, at p. 16. 53 Royal College of Physicians, Ethics in Practice: Background and Recommendations for Enhanced Support , 2005, London, Royal College of Physicians, at p. 25. 54 London, November 2006. 55 para 9.37 see also paragraphs 8.48–8.49. 56 Royal College of Physicians, Ethics in Practice: Background and Recommendations for Enhanced Support , London: Royal College of Physicians, 2005, at p. 25. 57 Beyleveld, D., et al. , ‘Clinical Ethics Committees: Clinician Support or Crisis Management,’ HEC Forum , 14, 1, 2002, 13–25, at p. 17. 58 Anzia, D.J., & La Puma, J., ‘Quality Care and Clinical Ethics,’ Quality Review Bulletin 1992, 18, 1, 21–23; Brennan, T.A., ‘Quality of Clinical Ethics Consultation,’ Quality Review Bulletin , 1992, 18, 1, 4–5; Siegler, M., ‘Defining the Goals of Ethics Consultations: A Necessary Step for Improving Quality,’ Quality Review Bulletin , 1992, 18, 1, 15–16. 59 Doyal, L., ‘Clinical Ethics Committees and the Formulation of Health Care Policy’, Journal of Medical Ethics 2001, 27 Suppl I: i.44–i.49, at p. i.49. 60 Benatar, D., ‘Bioethics and Health and Human Rights: A Critical View,’ Journal of Medical Ethics , 32, 2006, 17–20. 61 Slowther, A., Johnston, C., Goodall, J., Hope, T., ‘Development of Clinical Ethics Committees,’ British Medical Journal , 328, 17 April 2004, 950–952, at p.950. 62 Orr, R.D., ‘Evaluation of an Ethics Consultation Service: Patient and Family Perspectives,’ American Journal of Medicine , 101, 1996, 135–141; McClung, J.A. et al., ‘Evaluation of Medical Ethics Consultation Service: Opinions of Patients and health Care Providers,’ 100, 1996, 456–460; Yen, B., & Schneiderman, ‘Impact of Pediatric Ethics Consultations on Patients, Families, Social Workers, and Physicians, Journal of Perinatology , 19, 5, 1999, 373–378. 63 Wolf, S.M., ‘Due Process in Ethics Committee Case Review,’ HEC Forum , 1992, 4, 2, 83–96, at p. 85 64 Fleetwood, J.E., Amold, R.M., and Baron, R.J., ‘Giving Answer or Raising Questions?’ The Problematic Role of Institutional Ethics Committees,’ Journal of Medical Ethics , 1989, 15, 137–142, at p. 137. 65 Craig, J.M., and May, T., ‘Evaluating the Outcomes of Ethics Consultation,’ Journal of Clinical Ethics , 17, 2, 168–180. 66 Fletcher, J.C., ‘Standards for Evaluations of Ethics Consultation,’ in Ethics Consultation in Health Care , Fletcher, J.C., Quist, N., Jonsen, A.R., (eds) 171–184, Michigan, Health Administration Press, 1989; Doyal, L., ‘Clinical Ethics Committees and the Formulation of Health Care Policy,’ Journal of Medical Ethics , 27, Suppl I, 2001, i44–i49. 67 Wolf, S. M., ‘Due Process in Ethics Committee Case Review’, H.E.C. Forum 1992, 4(2): 83–96, at p. 84. 68 For discussion on a related point,, see Annas, G. J., ‘Ethics Committees: From Ethical Comfort to Ethical Cover’, Hastings Center Report , May–June 1991, 18–21. 69 Orlowksi, J.P., Hein, S., Christensen, J.A., Meinke, R., and Sincich, T., ‘Why doctors use or do not use ethics consultation’, Journal of Medical Ethics 2006; 32: 499–502. 71 at p. 501. 70 at p. 501. 71 Id. 72 Povar, G.J., ‘Evaluating Ethics Committees: What do we mean by Success?’ Maryland Law Review , 1991, 50, 904–919 at p. 907. 73 Campbell, A.V., ‘Clinical governance — watchword or buzzword?’, Journal of Medical Ethics 2001, 27 Suppl I: i54–i56, at p. i.56. 74 Article 6 states that ‘In the determination of his civil rights and obligations or of any criminal charge against him, everyone is entitled to a fair and public hearing within a reasonable time by an independent and impartial tribunal established by law.’ 75 Van der Kloot Meijburg, H.H., ter Meulen, R.H.J., ‘Developing Standards for Institutional Ethics Committees: Lessons from the Netherlands’, Journal of Medical Ethics 2001, 27 Suppl I: i36–i40, at p. i3 7. 76 Godkin, M.D. et al, ‘Project Examining Effectiveness in Clinical Ethics (PEECE): phase 1 — descriptive analysis of nine clinical ethics services’, Journal of Medical Ethics 2005, 31: 505–512, at p. 511
PY - 2007
Y1 - 2007
N2 - In the United Kingdom there is a growing conviction that CECs have an important role to play in helping health care professionals address ethical dilemmas. For example, the Royal College of Physicians, the Nuffield Trust and the unofficial Clinical Ethics Network, which has received financial support from the Department of Health, commend the use of CECs in the UK. The growth of such committees has been influenced by the legal and policy support they have received in the United States. However, there is increasing concern about both the benefits and the quality of work produced by CECs. In addition, despite the rapid increase in the number of CECs in the UK, outside of the United States they remain under-researched and no formal mechanism exists to assess their performance. As a result we know little about the structure, function, impact and effectiveness of CECs. We are currently conducting a research project funded by the Wellcome Trust that seeks to interrogate the competing claims regarding the benefits and disbenefits of CECs. This initial account of our research provides a detailed analysis of theoretical issues that surround the development and use of CECs and points towards the questions that lie at the heart of the social science strand of our project.
AB - In the United Kingdom there is a growing conviction that CECs have an important role to play in helping health care professionals address ethical dilemmas. For example, the Royal College of Physicians, the Nuffield Trust and the unofficial Clinical Ethics Network, which has received financial support from the Department of Health, commend the use of CECs in the UK. The growth of such committees has been influenced by the legal and policy support they have received in the United States. However, there is increasing concern about both the benefits and the quality of work produced by CECs. In addition, despite the rapid increase in the number of CECs in the UK, outside of the United States they remain under-researched and no formal mechanism exists to assess their performance. As a result we know little about the structure, function, impact and effectiveness of CECs. We are currently conducting a research project funded by the Wellcome Trust that seeks to interrogate the competing claims regarding the benefits and disbenefits of CECs. This initial account of our research provides a detailed analysis of theoretical issues that surround the development and use of CECs and points towards the questions that lie at the heart of the social science strand of our project.
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UR - http://www.scopus.com/inward/citedby.url?scp=35349025520&partnerID=8YFLogxK
U2 - 10.1177/096853320700800302
DO - 10.1177/096853320700800302
M3 - Review article
AN - SCOPUS:35349025520
VL - 8
SP - 221
EP - 237
JO - Medical Law International
JF - Medical Law International
SN - 0968-5332
IS - 3
ER -