Clinical ethics committeeBMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7006.667 (Published 09 September 1995) Cite this as: BMJ 1995;311:667
- J G Thornton, reader in obstetrics and gynaecologya,
- R J Lilford, professor of obstetrics and gynaecologya
- a Institute of Epidemiology and Health Services Research, Leeds LS2 9LN
- Correspondence to: Dr Thornton.
- Accepted 2 June 1995
An informal clinical ethics committee was set up to advise on ethical problems in prenatal diagnosis in Leeds. It was used twice in six months but was not called on again in the subsequent year, and we describe this experience. In North America similar committees are often used to advise on clinical moral dilemmas, and we review the published evidence from there and discuss some of the advantages and problems. Our committee's advice may have altered clinicians' actions considerably, but perhaps doctors in Britain are not yet ready to surrender this aspect of clinical autonomy.
With the exception of those concerned with assisted conception, ethics committees concerned with clinical matters are little used in Britain. In contrast they play an important part in clinical practice in the United States and Canada.1 2 3 4 5 6 In our prenatal diagnosis practice we are occasionally faced with ethical dilemmas such as requests for feticide in the third trimester. Although the HumanFertilisation and Embryology Act allows this when there is a “substantial risk…[of]…serious handicap,” we are unsure what is meant by serious in this context and uncertain how to act if parents and doctors disagree.7 Such moral problems are increasingly common: we have recently considered requests for diagnosis of sex and paternity, for termination for cystic fibrosis or Duchenne dystrophy at residual risks below 1%, and for reducing multifetal pregnancy, often backed by the threat to terminate anyway if we refused.
We therefore set up an informal advisory group to provide independent advice in such difficult circumstances. We report our initial experience and review the literature on the use of such committees in other countries.
The ethics committee
The committee had no special authority, and its advice had the same status as that from any other professional consultation. The members consisted of a …