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Ethics committees in England.

Ethics Committees in England

There's a joke the English make at their own expense, to the effect that if they really need action what they do is form a committee. However, when it comes to setting up hospital ethics committees it seems that, certainly so far, no need for action has been perceived. For whereas it's been estimated that in the United States 60 percent or more of all hospitals have ethics committees, in England, with the exception of a couple of psychiatric hospitals, none do.

Dr. Richard Nicholson, a pediatrician and editor of the Bulletin of the Institute of Medical Ethics, believes that there remains in England "a very strong sense that doctors have complete clinical autonomy: a necessary corollary is that they should take complete responsibility for their clinical actions, and that such responsibility should not be diluted by allowing a committee to be involved in making decisions."

"Indeed," Dr. Nicholson continues, "doctors are supported in such attitudes by the advice given to them by the General Medical Council, which controls the medical profession in the United Kingdom. Its guidance on professional conduct includes the following: 'It is also important that the doctor should retain ultimate responsibility for the management of his patients because only the doctor has received the necessary training to undertake this responsibility.'" Dr. Nicholson would like to see a controlled trial set up "to see whether hospital ethics committees really do serve a useful purpose in improving patient care."

The director of the Patients' Association, Mrs. Linda Lamont, would like to see research ethics committees, which do already exist in England, expanded to become more like the hospital ethics committees in America. She would also like to see more publicity about ethics committees and greater lay representation on them. And they should have, she feels, "meaningful," but not restrictive guidelines. "But I don't think it would be in anyone's interests for us to end up in a situation similar to America where you need preinsurance almost before you breathe in case something's actionable."

Dr. Michael Lockwood, staff tutor in philosophy at Oxford University's Department for External Studies, London, thinks ethics committees are "an excellent idea. That is provided they have a substantial number of lay people on them because all the evidence we have from research ethics committees suggests they only really began to get any teeth when they had lay members." Without lay members there will be, he feels, a strong tendency for ethics committees to be "a rubber stamp for whatever doctors want to do."

While Dr. Peter Toon was lecturing on general practice at St. Bartholomew's and the London Hospital Medical Colleges some time ago, he was involved in setting up what was possibly the nearest thing England had at the time to a hospital ethics committee in a general hospital. Together with other colleagues he began an informal group at the London Hospital that discussed the ethical dilemmas the members of the group were experiencing. (However, the group has since ceased to meet due to the pressue of other commitments.)

"It is in that sort of milieu," Toon says, "that I could imagine the concept of the ethics committee being implemented here. I think it would be unlikely in the climate of British culture, both as far as the doctor, and indeed the patient were concerned, for the concept of a committee to be particularly attractive. I think a lot of doctors would not find that easy to accept.

"What I would like to see rather than the ethics committees as they are set up in the States is the team concerned with a patient sitting down and discussing the issues among themselves, maybe with a consultant outsider who can take a dispassionate view. That consultant could be, perhaps, a philosopher or someone with theological training. A team concerned with, for instance, geriatric patients, might consist of doctors, nurses, occupational therapists, physiotherapists, and, as I said, a consultant outsider. I feel there's more of a future in this country for the concept of an ethical consultant, which is incidentally another American idea, than there is for the ethics committee."
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Title Annotation:hospital ethics committees
Author:Lloyd, Ann
Publication:The Hastings Center Report
Date:Oct 1, 1988
Words:689
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