Ethical dilemmas need round the clock advice

Ethics support is needed everywhere healthcare is provided; therefore anyone providing healthcare should have round-the-clock access to appropriate sources of ethical advice, says a new report from the Royal College of Physicians. 

Health care institutions should review their existing arrangements for providing ethical support, and develop and implement guidelines on how to recognise and handle ethical advice.  If complex dilemmas occur frequently, it may be considered appropriate to set up a Clinical Ethics Committee.

Medical practitioners are encountering ethical uncertainties and dilemmas daily, due to advances in medical technology; legal developments; more intense scrutiny of and challenge to medical decision-making by patients, the public and the media; the breakdown of consensus in a culturally diverse society; and a multiplicity of guidelines and emergency bodies.  Current provision of ethics support is uneven and often depends upon the enthusiasm of individuals.

Against this background, the Royal College of Physicians set up a working party to examine the need for local support for ethical judgement in clinical practice.  The resulting report ‘Ethics in Practice:  Background and recommendations for enhanced support’ covers current provision of ethical advice nationally and locally, the provision of education and training in clinical ethics, and the role of the clinical ethicist.  The summary and recommendations are attached.

The report includes the results of a survey of Specialist Registrars in medicine revealing that one third of tomorrow’s consultant physicians believe they have never had education or training in clinical ethics.  Of those who believe they have received training, three quarters state their education in clinical ethics either did not provide them, or only sometimes provided them, with the skills they needed to address the ethical issues arising in their clinical practice.  These results show a clear need for ongoing education and training in those areas of clinical ethics relevant to physicians’ practice.

Professor Michael Parker, Professor of Bioethics and Director of the Ethox Centre at the University of Oxford, who drafted the report on behalf of the working party, said:

“Clinical ethics committees and other forms of ethics support in the United Kingdom are increasing rapidly  - not because they are being imposed from above as yet another bureaucratic hurdle - but because health professionals working with patients such as doctors and nurses, are asking for them and in many cases establishing them themselves.  The findings of this report suggest that health professionals are increasingly recognising the need for access to appropriate forms of ethics support and advice to help them with their day-to-day practice. The UK Clinical Ethics Network is playing a key role in facilitating the development of this support.  The report also suggests that the widespread development of forms of appropriate ethics advice that are genuinely supportive to health professionals is best encouraged through the bottom-up approach exemplified by the work of the network.”

Professor Ray Tallis, Professor of Geriatric Medicine at the University of Manchester and Chair of the working party, said:

“This report has identified an important gap in the support for doctors making clinical decisions in an increasingly challenging ethical and legal environment.  The report makes a wide range of suggestions as to how this gap may be closed and offers timely advice to doctors who may often have to make diffiult ethical decisions in the context of a rapidly evolving clinical situation.  This report will foster the best interests of patients and doctors will receive guidance in which they can feel confidence.”

Professor John Saunders, Honorary Professor at the Centre for Philosophy, Humanities and Law in Health Care at the University of Swansea, and Chairman of the RCP Ethical Issues in Medicine Committee, said:

“This report should lead to further discussion about the provision of ethics advice.  The report is open minded about the clinical ethics committee, which requires skills, enthusiasm and support that may not be readily available everywhere.  We are united however I the conclusion that some formal structure for the provision of advice is essential.  Competencies to do this work need definition and the report should assist continuing debate on these concerns.”

Ethics in practice: background and recommendations for enhanced support (PDF)