Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Editor - We disagree with Leavitt's scepticism about the Slowther
and Hope's editorial on the role of ethics committees.
It is unquestionable that modern medical science and clinical practice
need ethical internal reflection. Today, physicians and clinical
researchers are faced with difficult and conflicting questions, more than
in the past. Sometimes, they wonder about the ethical boundaries of the
medical science.
The complexity of situations often requires a specific training and
adequate methodology on ethical issues. Therefore, ethics committees and
bioethics consultants are important, but their existence does not
eliminate the direct legal and moral responsibility of physicians and
clinical researchers. In fact, except very rare and difficult cases, they
are the only ones to make own decisions, after all. Moreover, the
multidisciplinary and specific contributions of ethics committees or
bioethics consultants strengthen decision more.
It is true that this opportunity for the health professionals could
be an excuse for not to read biomedical ethics literature and not to
deepen the reflection about bioethical issues in health care and research,
but just one of the functions of ethics committees is the permanent
education of health professionals within their institution.
Regarding the risks of enslaving the ethics committees to the interests of
health management and the temptation of "standardising" the biomedical
ethics, we think that ethics committees must be independent but referring
to universally acknowledged values and fundamental principles. In our
opinion, the fundamental value is the human life in its wholeness. All
other criteria would be subordinated and related to that.
In spite of the majority of local ethics committees perform prevalently
the function of reviewing clinical research the Italian National Bioethics
Committee has emphasised in a forthcoming document the role of ethics
committees in clinical practice. The sorts of roles that Italian Committee
does outline include the retrospective or prospective discussion of
individual cases, development of guidelines for cases that tend to recur
and acting as a consultative body for health professionals who seek advice
on a particular ethical problem. We think that it is positive for helping
medical world to begin and to go deep into the ethical reflection of the
clinical practice, provided that not to lose the educational and
consulting role.
Roberta Minacori, specialist in legal medicine,
Dario Sacchini, doctorate in bioethics,
Maria L. Di Pietro, senior researcher in bioethics,
Antonio G. Spagnolo, associate professor of bioethics
3. Wray E, Ethics Committees in Italy - A time for change? Bull.
Med. Eth; 160: 13-6
Dr Roberta Minacori is a member of ethics committe of "Sandro
Pertini" Hospital, Dr. Dario Sacchini is a member of ethics committee of
"S Camillo - Forlanini" Hospital, Dr Maria L Di Pietro is a member of
ethics committee of "S Filippo Neri" Hospital, Professor Antonio G.
Spagnolo is a member of ethics committtee of "Agostino Gemelli" Hospital,
in Rome.
Functions and value of ethics committee in clinical practice
Editor - We disagree with Leavitt's scepticism about the Slowther
and Hope's editorial on the role of ethics committees.
It is unquestionable that modern medical science and clinical practice
need ethical internal reflection. Today, physicians and clinical
researchers are faced with difficult and conflicting questions, more than
in the past. Sometimes, they wonder about the ethical boundaries of the
medical science.
The complexity of situations often requires a specific training and
adequate methodology on ethical issues. Therefore, ethics committees and
bioethics consultants are important, but their existence does not
eliminate the direct legal and moral responsibility of physicians and
clinical researchers. In fact, except very rare and difficult cases, they
are the only ones to make own decisions, after all. Moreover, the
multidisciplinary and specific contributions of ethics committees or
bioethics consultants strengthen decision more.
It is true that this opportunity for the health professionals could
be an excuse for not to read biomedical ethics literature and not to
deepen the reflection about bioethical issues in health care and research,
but just one of the functions of ethics committees is the permanent
education of health professionals within their institution.
Regarding the risks of enslaving the ethics committees to the interests of
health management and the temptation of "standardising" the biomedical
ethics, we think that ethics committees must be independent but referring
to universally acknowledged values and fundamental principles. In our
opinion, the fundamental value is the human life in its wholeness. All
other criteria would be subordinated and related to that.
In spite of the majority of local ethics committees perform prevalently
the function of reviewing clinical research the Italian National Bioethics
Committee has emphasised in a forthcoming document the role of ethics
committees in clinical practice. The sorts of roles that Italian Committee
does outline include the retrospective or prospective discussion of
individual cases, development of guidelines for cases that tend to recur
and acting as a consultative body for health professionals who seek advice
on a particular ethical problem. We think that it is positive for helping
medical world to begin and to go deep into the ethical reflection of the
clinical practice, provided that not to lose the educational and
consulting role.
Roberta Minacori, specialist in legal medicine,
Dario Sacchini, doctorate in bioethics,
Maria L. Di Pietro, senior researcher in bioethics,
Antonio G. Spagnolo, associate professor of bioethics
ibiet@rm.unicatt.it
Institute of Bioethics, Catholic University of Sacred Heart, School of
Medicine,
1, Largo Francesco Vito, 1 - 00168 Rome (Italy)
1. Leavitt F, Hospital ethics committees may discourage staff from
making own decisions. BMJ 2000; 321: 1414.
2. Slowther A-M, Hope T, Clinical ethics committees. BMJ 2000, 321:
649-50.
3. Wray E, Ethics Committees in Italy - A time for change? Bull.
Med. Eth; 160: 13-6
Dr Roberta Minacori is a member of ethics committe of "Sandro
Pertini" Hospital, Dr. Dario Sacchini is a member of ethics committee of
"S Camillo - Forlanini" Hospital, Dr Maria L Di Pietro is a member of
ethics committee of "S Filippo Neri" Hospital, Professor Antonio G.
Spagnolo is a member of ethics committtee of "Agostino Gemelli" Hospital,
in Rome.
Competing interests: No competing interests