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Letters

Hospital ethics committees may discourage staff from making own decisions

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7273.1414/a (Published 02 December 2000) Cite this as: BMJ 2000;321:1414
  1. Frank (Yeruham) Leavitt (yeruham{at}bgumail.bgu.ac.il), chairman
  1. Centre for Asian and International Bioethics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel

    EDITOR—I am sceptical about the value of clinical ethics committees.1

    Firstly, having a hospital ethicist or ethics committee can allow the ward staff to let others take the responsibility for hard decisions: “The ethicists said it was OK. What do you want of me?”

    Secondly, the existence of ethicists and their committees can be an excuse for ward staff not to read biomedical ethics literature themselves and not to think deeply about bioethical questions.

    Thirdly, ethicists and members of ethics committees who are hired or appointed by hospitals, national health services, or sick fund managements may naturally be selected to serve the interests of management. This can range from not interfering with experimentation that management wants to pursue to having liberal “do not resuscitate” policies to save resources.

    Fourthly, there is no reason why every hospital in a country, or every ward in a hospital, should have the same policy about non-resuscitation and other ethically sensitive issues. Life and death are too complicated for ethical uniformity, let alone universalisation. Hospital ethicists and ethics committees tend to push for uniform policies for an entire hospital, discouraging creative, sensitive case by case thinking by the ward staff concerned.

    As a philosopher-bioethicist (not a doctor) in a medical school, I deplore efforts by my colleagues to encourage the existence of clinical ethics committees and hospital clinical ethicists. Instead I think our function should be educational, helping present and future doctors and nurses to learn to think deeply, systematically, and for themselves about life, death, and their ethics. Rather than passing the responsibility on to others, they should make ethics decisions ward decisions: to be made not by individuals but in ward staff meetings that include the nurses and social workers—and the patient and family whenever possible.

    References

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